Provider Demographics
NPI:1992074652
Name:ALLEN, PRISCILLA JO BRYAN (PMHNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:JO BRYAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-BC
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 2723
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-2723
Mailing Address - Country:US
Mailing Address - Phone:252-212-6802
Mailing Address - Fax:252-212-3497
Practice Address - Street 1:90 GUARDIAN CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3017
Practice Address - Country:US
Practice Address - Phone:252-212-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227627163W00000X
NC5005422363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily