Provider Demographics
NPI:1477586147
Name:MCCOLLOW, SUSAN K (MSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:MCCOLLOW
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MC 7977
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-257-1400
Mailing Address - Fax:210-257-1428
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:MC 7977
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-257-1400
Practice Address - Fax:210-257-1428
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145745904OtherCSHCN
TX145745903Medicaid
TX8L11172Medicare PIN
TX145745904OtherCSHCN