Provider Demographics
NPI:1972555258
Name:COLLINS, KELLY DENENE GONZALES (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DENENE GONZALES
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 1:2211 CAPEHART RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-2121
Mailing Address - Country:US
Mailing Address - Phone:402-933-4111
Mailing Address - Fax:402-934-4111
Practice Address - Street 1:2211 CAPEHART RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-2121
Practice Address - Country:US
Practice Address - Phone:402-933-4111
Practice Address - Fax:402-934-4111
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE23335OtherSTATE LICENSE