Provider Demographics
NPI:1154937670
Name:ALLEN, WILLIAM RICHARD
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RICHARD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 96TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25315-1843
Mailing Address - Country:US
Mailing Address - Phone:828-390-0381
Mailing Address - Fax:
Practice Address - Street 1:301 96TH ST APT A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25315-1843
Practice Address - Country:US
Practice Address - Phone:828-390-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant