Provider Demographics
NPI:1033343728
Name:COLLINS, KIMBERLY ROCHELLE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROCHELLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 MURFREESBORO PIKE STE 201
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2000
Mailing Address - Country:US
Mailing Address - Phone:615-915-2226
Mailing Address - Fax:629-202-7956
Practice Address - Street 1:2711 MURFREESBORO PIKE STE 201
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2000
Practice Address - Country:US
Practice Address - Phone:615-915-2226
Practice Address - Fax:629-202-7956
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44474207Q00000X, 208M00000X
TN52004207Q00000X, 207QA0401X
TNMD52005208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100164440Medicaid
KY7100164440Medicaid