Provider Demographics
NPI:1972552198
Name:COLLINS, VICKIE RENEE (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:RENEE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:MRS
Other - First Name:VICKI
Other - Middle Name:RENEE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1970 JORDAN AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1900
Mailing Address - Country:US
Mailing Address - Phone:423-790-7662
Mailing Address - Fax:423-790-7664
Practice Address - Street 1:1970 JORDAN AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1900
Practice Address - Country:US
Practice Address - Phone:423-790-7662
Practice Address - Fax:423-790-7664
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11917363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q70165Medicare UPIN
TN3643045Medicare PIN