Provider Demographics
NPI:1326544305
Name:JANES, COLLEEN MICHELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MICHELLE
Last Name:JANES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-0740
Mailing Address - Country:US
Mailing Address - Phone:870-584-3000
Mailing Address - Fax:870-584-3003
Practice Address - Street 1:1553 W COLLIN RAYE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-3801
Practice Address - Country:US
Practice Address - Phone:870-584-3000
Practice Address - Fax:870-584-3003
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily