Provider Demographics
NPI:1790870194
Name:ALLEN, AUDREY KAY (NP-C)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:KAY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 SHERRILL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-3330
Mailing Address - Country:US
Mailing Address - Phone:865-373-5050
Mailing Address - Fax:865-373-5051
Practice Address - Street 1:9711 SHERRILL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3330
Practice Address - Country:US
Practice Address - Phone:865-373-5050
Practice Address - Fax:865-373-5051
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704219757363LA2200X, 363LP2300X
KY0385214363LA2200X
TN20725363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100463030Medicaid
TNQ025810Medicaid
MI4845185Medicaid