Provider Demographics
NPI:1902829609
Name:COLLINS, NANCY KAREN (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KAREN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 GILCHRIST DR
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-6671
Mailing Address - Country:US
Mailing Address - Phone:601-939-0700
Mailing Address - Fax:601-939-8654
Practice Address - Street 1:342 GILCHRIST DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-6671
Practice Address - Country:US
Practice Address - Phone:601-939-0700
Practice Address - Fax:601-939-8654
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0122294Medicaid
MS0122294Medicaid