Provider Demographics
NPI:1467413849
Name:COLLINS, KATHLYNN L (FNP/MSN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLYNN
Middle Name:L
Last Name:COLLINS
Suffix:
Gender:F
Credentials:FNP/MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 CELESTE DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2402
Mailing Address - Country:US
Mailing Address - Phone:209-527-6900
Mailing Address - Fax:209-524-7328
Practice Address - Street 1:1320 CELESTE DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2402
Practice Address - Country:US
Practice Address - Phone:209-527-6900
Practice Address - Fax:209-524-7328
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner