Provider Demographics
NPI:1023620267
Name:COLLINS, KATELYN
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:LYNCO
Mailing Address - State:WV
Mailing Address - Zip Code:24857-0402
Mailing Address - Country:US
Mailing Address - Phone:325-225-1823
Mailing Address - Fax:
Practice Address - Street 1:29 JACKSON HILL RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:WV
Practice Address - Zip Code:24874-7503
Practice Address - Country:US
Practice Address - Phone:325-225-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant