Provider Demographics
NPI:1235652306
Name:COLLETTE, KATHRYN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:COLLETTE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:12502 WILLOWBROOK RD STE 660
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6579
Mailing Address - Country:US
Mailing Address - Phone:240-964-8760
Mailing Address - Fax:240-964-8769
Practice Address - Street 1:12502 WILLOWBROOK RD STE 660
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6579
Practice Address - Country:US
Practice Address - Phone:240-964-8760
Practice Address - Fax:240-964-8769
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220774163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse