Provider Demographics
NPI:1235822412
Name:COLLINS, JASMINE DANIELLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:DANIELLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 GATEWOOD CT APT C
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2531
Mailing Address - Country:US
Mailing Address - Phone:708-205-2966
Mailing Address - Fax:
Practice Address - Street 1:3409 GATEWOOD CT APT C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-2531
Practice Address - Country:US
Practice Address - Phone:708-205-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant