Provider Demographics
NPI:1336487412
Name:COLLINS, JILL S (APRN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:COLLINS
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 1:1110 COLUMBINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436
Mailing Address - Country:US
Mailing Address - Phone:785-364-2126
Mailing Address - Fax:785-364-9612
Practice Address - Street 1:1110 COLUMBINE DRIVE
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436
Practice Address - Country:US
Practice Address - Phone:785-364-2126
Practice Address - Fax:785-364-9612
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002210OtherMEDICARE PTAN
KS201001310AMedicaid