Provider Demographics
NPI:1467239095
Name:COLLINS, KELLI R
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:R
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 NATIONAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1192
Mailing Address - Country:US
Mailing Address - Phone:240-755-8089
Mailing Address - Fax:202-217-4444
Practice Address - Street 1:3909 NATIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1192
Practice Address - Country:US
Practice Address - Phone:240-755-8089
Practice Address - Fax:202-217-4444
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program