Individual
MR. CHARLES ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
2321 TROOST AVE STE 101, KANSAS CITY, MO 64108-2834
(816) 200-2409
(816) 320-0028
Mailing address
PO BOX 18361, KANSAS CITY, MO 64133-8361
(816) 200-2409
(816) 320-0028
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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