Provider Demographics
NPI:1396837654
Name:COLLINS, JAYNE D (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:D
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
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 320
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05667-0320
Mailing Address - Country:US
Mailing Address - Phone:802-454-8336
Mailing Address - Fax:
Practice Address - Street 1:157 TOWNE AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:VT
Practice Address - Zip Code:05667-9425
Practice Address - Country:US
Practice Address - Phone:802-454-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0031172363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT5227OtherBCBS PHYSICAL THERAPY
VT445721OtherCIGNA PT PROVIDER
VT43V041OtherMVP PT PROVIDER
VT650014228OtherMEDICARE RAILROAD
VTOVN0070Medicaid
VTOVN0070Medicaid