Provider Demographics
NPI:1124658430
Name:ALLEN, FAWNA R (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:FAWNA
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 BRANDING IRON CT
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-8902
Mailing Address - Country:US
Mailing Address - Phone:575-652-9799
Mailing Address - Fax:
Practice Address - Street 1:375 FM 548 STE 100
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-6985
Practice Address - Country:US
Practice Address - Phone:575-652-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-26
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1094478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty