Provider Demographics
NPI:1134602840
Name:COLLINS, PAULA GAYLE
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:GAYLE
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 1:4619 S CONGRESS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2342
Mailing Address - Country:US
Mailing Address - Phone:512-443-3315
Mailing Address - Fax:
Practice Address - Street 1:4619 S CONGRESS AVE STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-2342
Practice Address - Country:US
Practice Address - Phone:512-443-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX806485174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty