Provider Demographics
NPI:1376739219
Name:SAUL-COLLINS, ELIZABETH ANN (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:SAUL-COLLINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5009
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-2895
Mailing Address - Country:US
Mailing Address - Phone:615-221-1400
Mailing Address - Fax:615-221-1484
Practice Address - Street 1:412 N LOCK AVE
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1115
Practice Address - Country:US
Practice Address - Phone:606-638-4595
Practice Address - Fax:606-638-9471
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5240D363LF0000X
WV69059363LF0000X
KY5240P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000276634Medicaid
WV613154600OtherBLACK LUNG
WV613154600OtherBLACK LUNG
KY1489315Medicare PIN