Provider Demographics
NPI:1518397132
Name:COLLINS, KEVIN L (FNP-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:COLLINS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6784
Mailing Address - Country:US
Mailing Address - Phone:423-855-2552
Mailing Address - Fax:423-855-9041
Practice Address - Street 1:6918 SHALLOWFORD RD
Practice Address - Street 2:SUITE 226
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6784
Practice Address - Country:US
Practice Address - Phone:423-855-0841
Practice Address - Fax:423-894-7726
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN138257163W00000X
TN18153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse