Provider Demographics
NPI:1568923530
Name:COLLINS, KATELYNN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATELYNN
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATELYNN
Other - Middle Name:MARIE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7915 ALBANY AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2881
Mailing Address - Country:US
Mailing Address - Phone:806-831-3055
Mailing Address - Fax:
Practice Address - Street 1:YOKOTA HOPSITAL
Practice Address - Street 2:UNIT 5701
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96328-5071
Practice Address - Country:US
Practice Address - Phone:806-831-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-30
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101271701208D00000X, 207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101271701OtherSTATE LICENSE