Provider Demographics
NPI:1184731416
Name:COLLINS-ALLEN, KEITH W (RN)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:W
Last Name:COLLINS-ALLEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:W
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,
Mailing Address - Street 1:548B BIRCHWOOD SQ APT 10
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2192
Mailing Address - Country:US
Mailing Address - Phone:347-547-6635
Mailing Address - Fax:775-254-5677
Practice Address - Street 1:548B BIRCHWOOD SQ APT 10
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2192
Practice Address - Country:US
Practice Address - Phone:347-547-6635
Practice Address - Fax:775-254-5677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262553163WA2000X, 163WC0400X, 163WC1500X, 163WC1600X, 163WG0000X, 163WG0600X, 163WH0200X, 163WH1000X, 163WI0500X, 163WI0600X, 163WP0000X, 163WP0809X, 163WP2201X, 163W00000X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00969993Medicaid