Provider Demographics
NPI:1780466961
Name:COLLINS, KIMBERLY TRINEE' (CPS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:TRINEE'
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-3827
Mailing Address - Country:US
Mailing Address - Phone:314-667-5255
Mailing Address - Fax:
Practice Address - Street 1:1426 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107-3827
Practice Address - Country:US
Practice Address - Phone:314-667-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator