Provider Demographics
NPI:1285035774
Name:COLLINS, FALICIA (LPN)
Entity Type:Individual
Prefix:
First Name:FALICIA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 WALTON LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3875
Mailing Address - Country:US
Mailing Address - Phone:316-461-9922
Mailing Address - Fax:
Practice Address - Street 1:1321 WALTON LN SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3875
Practice Address - Country:US
Practice Address - Phone:316-461-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN087644164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse