Provider Demographics
NPI:1417926296
Name:COLLINS, KIMBERLY B (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
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 1:130 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5921
Mailing Address - Country:US
Mailing Address - Phone:860-646-6210
Mailing Address - Fax:860-645-3363
Practice Address - Street 1:130 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5921
Practice Address - Country:US
Practice Address - Phone:860-646-6210
Practice Address - Fax:860-645-3363
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002925363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT020925OtherCONNECTICARE
CT400002925CT01OtherBC/BS
CTC003687OtherCHAMPUS
CT00424681600OtherBC/BS FAMILYPLAN
CT004246816Medicaid
CT2V5976OtherHEALTHNET
CT890000516Medicare PIN
CT400002925CT01OtherBC/BS