Basic Information
| Provider Information | |||||||||
| NPI: | 1396837654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | JAYNE | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 320 | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056670320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024548336 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 157 TOWNE AVE | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056679425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024548336 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 055-0031172 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 5227 | 01 | VT | BCBS PHYSICAL THERAPY | OTHER | 445721 | 01 | VT | CIGNA PT PROVIDER | OTHER | 43V041 | 01 | VT | MVP PT PROVIDER | OTHER | 650014228 | 01 | VT | MEDICARE RAILROAD | OTHER | OVN0070 | 05 | VT | MEDICAID |