Active NPI
Johnathan D Allen, BS, QBHP
- Case Manager/Care Coordinator
- Fayetteville, AR
National Provider Identifier
1114560109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 2153 E Joyce Blvd Ste 201
Fayetteville, AR 72703-5285 - Phone
- (479) 575-9471
- Fax
- (417) 761-5065
- NPI assigned
- Oct 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | AR | Primary |
Addresses
Primary practice location
2153 E Joyce Blvd Ste 201
Fayetteville, AR 72703-5285
Mailing address
2153 E Joyce Blvd Ste 201
Fayetteville, AR 72703-5285
Phone (479) 575-9471
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571702400000",
"number": "1114560109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2153 E JOYCE BLVD STE 201",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727035285",
"telephone_number": "479-575-9471",
"fax_number": "417-761-5065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2153 E JOYCE BLVD STE 201",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727035285",
"telephone_number": "479-575-9471",
"fax_number": "417-761-5065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "JOHNATHAN",
"middle_name": "D",
"credential": "BS, QBHP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-22",
"last_updated": "2019-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "AR",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.