Provider Demographics
NPI:1982706040
Name:ALLEN, JENNIFER READ (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:READ
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6266 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11911 N. MERIDIAN STREET
Practice Address - Street 2:SUITE 150
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4640
Practice Address - Country:US
Practice Address - Phone:317-621-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9374363A00000X
IN10001398A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0110157OtherMEDICA
MN6608745OtherMEDICA URGENT CARE
MNHP28337OtherHEALTHPARTNERS
MN47F11ALOtherBCBS OF MN
MN1020261OtherPREFERRED ONE
MN129226OtherUCARE MN
MN928735OtherAMERICA'S PPO
MN140127100Medicaid
MNHP28337OtherHEALTHPARTNERS
MN928735OtherAMERICA'S PPO
MN6608745OtherMEDICA URGENT CARE
MNP00590Medicare UPIN