Basic Information
Provider Information
NPI: 1932541265
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLLINS
FirstName: CAMERON
MiddleName: LEIGH
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1701 WESTCHESTER DR
Address2: SUITE 850
City: HIGH POINT
State: NC
PostalCode: 272627008
CountryCode: US
TelephoneNumber: 3368022400
FaxNumber: 3368022534
Practice Location
Address1: 305 1ST ST E
Address2:  
City: CONOVER
State: NC
PostalCode: 28613
CountryCode: US
TelephoneNumber: 8284643821
FaxNumber: 8284648994
Other Information
ProviderEnumerationDate: 07/29/2013
LastUpdateDate: 06/26/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X5006316NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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