Provider Demographics
NPI:1215483920
Name:ALLEN, MAGGIE (DNP, FNP)
Entity type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:500 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5010
Practice Address - Country:US
Practice Address - Phone:432-335-8275
Practice Address - Fax:432-334-0687
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX864242363LF0000X
OK100447363LF0000X
TXAP131551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363283801Medicaid
TX363283801Medicaid