Provider Demographics
NPI:1336178805
Name:COLLINS, KIMBERLY JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JANE
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 1:15100 N 593 RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-1911
Mailing Address - Country:US
Mailing Address - Phone:918-453-9154
Mailing Address - Fax:
Practice Address - Street 1:15100 N 593 RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-1911
Practice Address - Country:US
Practice Address - Phone:918-822-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8113207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3118113Medicaid
OK3118113Medicaid