Charles Allen, NURSE PRACTITIONER

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1427617729 Issued in GA

Practice address

2321 Troost Ave Ste 101
Kansas City, MO 64108-2834

Phone

(816) 200-2409

Fax

(816) 320-0028

NPI assigned

Jan 25, 2022

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aesthetic Luxury Spa LLC

  • Clinical Laboratory Director (Non-physician)
  • Kansas City, MO
  • NPI 1518611904
  NPD

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 21, 2023.

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1275285751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18361",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641338361",
            "telephone_number": "816-200-2409",
            "fax_number": "816-320-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 TROOST AVE STE 101",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641082834",
            "telephone_number": "816-200-2409",
            "fax_number": "816-320-0028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "417 SW Ward Rd",
            "address_purpose": "LOCATION",
            "city": "Lees Summit",
            "state": "MO",
            "postal_code": "640812448",
            "country_code": "US",
            "telephone_number": "816-200-2409",
            "fax_number": "816-320-0028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-01-25",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1201X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": "MO",
            "license": "134659711",
            "primary": false
        },
        {
            "code": "174V00000X",
            "taxonomy_group": "",
            "desc": "Clinical Ethicist",
            "state": "GA",
            "license": "1427617729",
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "1427617729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2301",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NA",
            "identifier": "417",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ann Allegre, MD
• Kayce Lynn Allen Hutton, BSN, RN, CEN
• Ace Allen, M.D.
• Alma Marie Allen
• Andrea Sanderson Allen, WHNP-C
• Charles Henry Allen III, DDS
• Colleen T Allen, DNP
• Emma Allen, DC
• Geoffrey L Allen, M.D.
• Gregory A Allen

• All providers in Kansas City, MO
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.