Provider Demographics
NPI:1063644185
Name:COLLINS, JENNY G (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:G
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:246 KY ROUTE 979
Practice Address - Street 2:
Practice Address - City:HAROLD
Practice Address - State:KY
Practice Address - Zip Code:41635-9046
Practice Address - Country:US
Practice Address - Phone:606-478-2200
Practice Address - Fax:866-310-9947
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant