Provider Demographics
NPI:1326626953
Name:COLLIER, JENNIFER LEIGH (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:COLLIER
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 BRIGADOON DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-0903
Mailing Address - Country:US
Mailing Address - Phone:512-590-1973
Mailing Address - Fax:
Practice Address - Street 1:10300 JENNY LIND RD STE 3
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-9101
Practice Address - Country:US
Practice Address - Phone:479-755-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date: