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Individual
MR. CHARLES ALLEN
Active
Individual
MR. CHARLES ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
134659711
MO
174V00000X
Clinical Ethicist
1427617729
GA
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1427617729
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2301
—
MO
01
—
417
NA
MO
Enumeration date
01/25/2022
Last updated
12/21/2023
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