Provider Demographics
NPI:1811135239
Name:COLLINS, JESSICA DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60248
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73146-0248
Mailing Address - Country:US
Mailing Address - Phone:405-272-6406
Mailing Address - Fax:405-272-6075
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:RM 1921
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-6406
Practice Address - Fax:405-272-6075
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant