Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 44474 | KY |
N | 207Q00000X | Family Doctor | 52004 | TN |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 52004 | TN |
NPI | 1033343728 |
---|---|
Provider Name | Kimberly Rochelle Collins |
First Address | Antioch, TN 37013-2000 |
Second Address | Antioch, TN 37013-2000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2009 |
Last Update Date | 28/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100164440 | (05) | KY |