Basic Information
| Provider Information | |||||||||
| NPI: | 1467413849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | KATHLYNN | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP/MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 CELESTE DR | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953552402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095276900 | ||||||||
| FaxNumber: | 2095247328 | ||||||||
| Practice Location | |||||||||
| Address1: | 1320 CELESTE DR | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953552402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095276900 | ||||||||
| FaxNumber: | 2095247328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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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 | 363L00000X | 191 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.