Basic Information
| Provider Information | |||||||||
| NPI: | 1801950225 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | MISTY | ||||||||
| MiddleName: | YOW | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15001 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | MILAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383585132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316132535 | ||||||||
| FaxNumber: | 7316132534 | ||||||||
| Practice Location | |||||||||
| Address1: | 15001 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | MILAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383585132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316132535 | ||||||||
| FaxNumber: | 7316132534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 41832 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 41832 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3832640 | 05 | TN | MEDICAID | 4153428 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 4146351 | 01 | BCBS | OTHER | 4146345 | 01 | BCBS | OTHER | 103I088826 | 05 | TN | MEDICAID |