Provider Demographics
NPI:1528357589
Name:COLLINS, KRISTINA
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
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 1:12 LOU CT
Mailing Address - Street 2:
Mailing Address - City:ROZET
Mailing Address - State:WY
Mailing Address - Zip Code:82727-8443
Mailing Address - Country:US
Mailing Address - Phone:307-685-6629
Mailing Address - Fax:
Practice Address - Street 1:12 LOU CT
Practice Address - Street 2:
Practice Address - City:ROZET
Practice Address - State:WY
Practice Address - Zip Code:82727-8443
Practice Address - Country:US
Practice Address - Phone:307-685-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services