Provider Demographics
NPI:1346992401
Name:ALLEN, COY LANE (PA)
Entity type:Individual
Prefix:
First Name:COY
Middle Name:LANE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3265 FARM ROAD 3281
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:TX
Mailing Address - Zip Code:75436-3720
Mailing Address - Country:US
Mailing Address - Phone:903-491-6575
Mailing Address - Fax:
Practice Address - Street 1:3055 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-3433
Practice Address - Country:US
Practice Address - Phone:903-739-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant