Provider Demographics
NPI:1083066591
Name:DEZARN, ALLISON DREW (APRN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:DREW
Last Name:DEZARN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1973
Mailing Address - Country:US
Mailing Address - Phone:606-487-9505
Mailing Address - Fax:606-436-0711
Practice Address - Street 1:279 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1973
Practice Address - Country:US
Practice Address - Phone:606-487-9505
Practice Address - Fax:606-436-0711
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010409363L00000X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner