Provider Demographics
NPI:1124533872
Name:ALLEN, KATIE JEAN (ARNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JEAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:JEAN
Other - Last Name:ERICHSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5372
Mailing Address - Fax:
Practice Address - Street 1:981 LITTON LN
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6340
Practice Address - Country:US
Practice Address - Phone:540-558-2400
Practice Address - Fax:540-953-5024
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60804361363LF0000X
VA0024180442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily