Basic Information
| Provider Information | |||||||||
| NPI: | 1326306374 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEVIN B. COLLEN, M.D. PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2809 ACKLEN AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372123311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159699680 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2011 ASHWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372125015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153834694 | ||||||||
| FaxNumber: | 6153830228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2012 | ||||||||
| LastUpdateDate: | 04/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | COLLEN | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6159699680 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 38029 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 3327656 | 05 | TN | MEDICAID |