Provider Demographics
NPI:1013922582
Name:MCCOLLUM, KAYLENE SHARON (APRN-C)
Entity type:Individual
Prefix:
First Name:KAYLENE
Middle Name:SHARON
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:KAYLENE
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE STE 2222
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4375
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:
Practice Address - Street 1:FAMILY PRACTICE CTR
Practice Address - Street 2:2400 TUCKER NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-8043
Practice Address - Fax:505-272-8044
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily