Provider Demographics
NPI:1154142180
Name:ALLEN, CATHERINE ALEXANDRA (MSN, APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ALEXANDRA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 PENROSE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1259
Mailing Address - Country:US
Mailing Address - Phone:912-665-8503
Mailing Address - Fax:
Practice Address - Street 1:4425 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3662
Practice Address - Country:US
Practice Address - Phone:912-355-6615
Practice Address - Fax:855-645-0468
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA290868363L00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner