Provider Demographics
NPI:1992495816
Name:ALLEN, KIARRA LANETTA
Entity type:Individual
Prefix:MRS
First Name:KIARRA
Middle Name:LANETTA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FLINTLOCK DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2615
Mailing Address - Country:US
Mailing Address - Phone:631-290-9751
Mailing Address - Fax:
Practice Address - Street 1:22 FLINTLOCK DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2615
Practice Address - Country:US
Practice Address - Phone:631-290-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator