Provider Demographics
NPI:1275862898
Name:COLLINS, SHELLI C (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SHELLI
Middle Name:C
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4316
Mailing Address - Country:US
Mailing Address - Phone:501-202-2093
Mailing Address - Fax:501-202-6316
Practice Address - Street 1:9601 BAPTIST HEALTH DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-202-2093
Practice Address - Fax:501-202-6316
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010004414367500000X
TXAP123498367500000X
ARC003199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01445979OtherRAILROAD
TX328640304Medicaid
MO600420027Medicaid
OK200446120AMedicaid
TX8564UJOtherBCBS
IL$$$$$$$$$001Medicaid
TXP01445979OtherRAILROAD
OK200446120AMedicaid
IL$$$$$$$$$001Medicaid