John Wynn Allen, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Clovis, CA
NPI 1669428447 · NPPES record last updated Apr 19, 2013
Key facts
- NPI
- 1669428447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- NA572 (CA)
- Practice address
- 2755 Herndon Ave
Clovis, CA 93611-6800 - Phone
- (559) 324-4000
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041213001118 | CA | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 3971560756 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29755 | CA | MD | Orthopedic Physical Therapist |
| NA572 | CA | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comfort Anesthesia Associates Inc | Current |
Accepting new patients | |
| Community Anesthesia Providers Medical Group Inc | Past | Accepting new patients |
Locations
2635 G St
Bakersfield, CA 93301
Phone (661) 633-1500
115 Mall Dr
Hanford, CA 93230
Phone (559) 537-0550
465 W Putnam Ave
Porterville, CA 93257
Phone (559) 784-8886
372 W Cypress Ave
Reedley, CA 93654
Phone (559) 391-3110
869 N Cherry St
Tulare, CA 93274
Phone (559) 326-2800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | NA572 | CA | Yes |
Addresses
Primary practice location
2755 Herndon Ave
Clovis, CA 93611-6800
Mailing address
PO Box 7096
Stockton, CA 95267-0096
Phone (209) 956-7725
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RN2929100 | Medicaid | CA | |
| NA572 | Other | CA | BS OF CA |
| 430079068 | Other | CA | RAILROAD MEDICARE |
Other providers in Clovis, CA
- Alfredo Lozano, LMFT
- Zeeshan Ali
- Vanessa Denise Alicea
- Jesse Adam Alifano
- Fatimah Aisha Allen
- Michael Zachary Allen
- Ngozi Mary Allison
- Aloha TMS a Medical Corporation
- Otto Raul Alonzo Dominguez
- Mark David Alson
All providers in Clovis, CA · Certified Registered Nurse Anesthetist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.