Provider Demographics
NPI:1558518472
Name:COLLINS, JESSICA MICHELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:APRN
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 489
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-0489
Mailing Address - Country:US
Mailing Address - Phone:229-768-2633
Mailing Address - Fax:229-768-2263
Practice Address - Street 1:106 HARTFORD RD E
Practice Address - Street 2:
Practice Address - City:FORT GAINES
Practice Address - State:GA
Practice Address - Zip Code:39851-3638
Practice Address - Country:US
Practice Address - Phone:229-768-2633
Practice Address - Fax:229-768-2263
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA688551706AMedicaid
AL1558518472Medicaid
GA688551706AMedicaid