Provider Demographics
NPI:1528008760
Name:COLLETT, PATRICIA L (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:COLLETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:ROCK CAVE
Mailing Address - State:WV
Mailing Address - Zip Code:26234-0217
Mailing Address - Country:US
Mailing Address - Phone:304-924-6262
Mailing Address - Fax:304-924-6699
Practice Address - Street 1:RT. 4 & 20 S INTERSECTION
Practice Address - Street 2:
Practice Address - City:ROCK CAVE
Practice Address - State:WV
Practice Address - Zip Code:26234
Practice Address - Country:US
Practice Address - Phone:304-924-6262
Practice Address - Fax:304-924-6969
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00510363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000539Medicaid
WV001721546OtherMS BCBS
WV3810000539Medicaid
WV2029682Medicare PIN
WV2029684Medicare PIN
WV2029687Medicare PIN
WV2029681Medicare PIN
WV2029686Medicare PIN
WV2029683Medicare PIN