Provider Demographics
NPI:1356105142
Name:COLLINS, MADISEN MARCIA-ANN (PA-C)
Entity type:Individual
Prefix:
First Name:MADISEN
Middle Name:MARCIA-ANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 BANDOLERO RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-2232
Mailing Address - Country:US
Mailing Address - Phone:210-883-8773
Mailing Address - Fax:
Practice Address - Street 1:1633 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3033
Practice Address - Country:US
Practice Address - Phone:325-672-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17621363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant