Provider Demographics
NPI:1902856990
Name:COLLINSON, KIM A (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:A
Last Name:COLLINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 W MORRIS BLVD STE A300
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-3877
Mailing Address - Country:US
Mailing Address - Phone:423-587-9949
Mailing Address - Fax:423-587-9828
Practice Address - Street 1:1907 W MORRIS BLVD STE A300
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3877
Practice Address - Country:US
Practice Address - Phone:423-587-9949
Practice Address - Fax:423-587-9828
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17566207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3023497Medicaid
TN3023497Medicaid
A98741Medicare UPIN