Provider Demographics
NPI:1639379175
Name:COLLINS, CHRISTINA KAY (APN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:KAY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:APN
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 69
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37824-0069
Mailing Address - Country:US
Mailing Address - Phone:423-259-5850
Mailing Address - Fax:423-259-5853
Practice Address - Street 1:409 CAWOOD RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879
Practice Address - Country:US
Practice Address - Phone:423-259-5850
Practice Address - Fax:423-259-5853
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010089363L00000X, 363LF0000X
TNAPN0000012828363L00000X, 363LP2300X
TN12828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003600Medicaid
TNQ003600Medicaid