Provider Demographics
NPI:1851864391
Name:COLLINS, AMY KRISTINA
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTINA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KRISTINA
Other - Last Name:CORIELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 GALLIA ST STE 600
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4097
Mailing Address - Country:US
Mailing Address - Phone:740-464-3116
Mailing Address - Fax:
Practice Address - Street 1:800 GALLIA ST STE 600
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4097
Practice Address - Country:US
Practice Address - Phone:740-464-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator