Provider Demographics
NPI:1770036154
Name:COLLINS, PAMELA K (APN, RXN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:COLLINS
Suffix:
Gender:F
Credentials:APN, RXN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:CO
Mailing Address - Zip Code:80102-7837
Mailing Address - Country:US
Mailing Address - Phone:303-204-7323
Mailing Address - Fax:
Practice Address - Street 1:475 PALMER AVE
Practice Address - Street 2:
Practice Address - City:BENNETT
Practice Address - State:CO
Practice Address - Zip Code:80102-7837
Practice Address - Country:US
Practice Address - Phone:303-204-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO70602163WA0400X, 163WC0400X, 163W00000X, 163WG0000X, 163WN1003X
CO0994559363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support