Provider Demographics
NPI:1760433288
Name:COLLINS, JESSICA ELLA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELLA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:144 MEDICAL CENTER DR
Mailing Address - Street 2:STE B
Mailing Address - City:COPPERHILL
Mailing Address - State:TN
Mailing Address - Zip Code:37317-5005
Mailing Address - Country:US
Mailing Address - Phone:423-496-9214
Mailing Address - Fax:423-496-7809
Practice Address - Street 1:144 MEDICAL CENTER DR
Practice Address - Street 2:STE B
Practice Address - City:COPPERHILL
Practice Address - State:TN
Practice Address - Zip Code:37317-5005
Practice Address - Country:US
Practice Address - Phone:423-496-9214
Practice Address - Fax:423-496-7809
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004460363A00000X
TNPA0000003154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA193898892AMedicaid
TNQ026000Medicaid
GAQ38677Medicare UPIN
TN1031879646Medicare PIN
TNQ026000Medicaid