Provider Demographics
NPI:1659923241
Name:COLLINS, MELISSA RENEE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
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 1:8130 E SILVERADO RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-7517
Mailing Address - Country:US
Mailing Address - Phone:918-361-1949
Mailing Address - Fax:
Practice Address - Street 1:8130 E SILVERADO RD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-7517
Practice Address - Country:US
Practice Address - Phone:918-361-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist