Provider Demographics
NPI:1427387935
Name:ALLAN, GARY LOUIS (DNP, PMHNP)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LOUIS
Last Name:ALLAN
Suffix:
Gender:M
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 UNSER BLVD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4045
Mailing Address - Country:US
Mailing Address - Phone:505-896-0928
Mailing Address - Fax:505-896-0585
Practice Address - Street 1:184 UNSER BLVD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4045
Practice Address - Country:US
Practice Address - Phone:505-896-0928
Practice Address - Fax:505-896-0585
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003143A363LP0808X
IN28079761A163WP0808X
NMCNP-02670363LP0808X
NMRN-81594163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2009010896OtherANCC - PSYCHIATRIC MENTAL HEALTH (ADULT) NURSE PRACTITIONER, BOARD CERTIFIED
NM2010012463OtherANCC-PSYCHIATRIC MENTAL HEALTH (LIFESPAN) NURSE PRACTITIONER, BOARD CERTIFIED