Provider Demographics
NPI:1932243219
Name:COLLINS, JENNIFER GAIL (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GAIL
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 1:207 16TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7906
Mailing Address - Country:US
Mailing Address - Phone:606-326-9700
Mailing Address - Fax:606-325-3664
Practice Address - Street 1:207 16TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7906
Practice Address - Country:US
Practice Address - Phone:606-326-9700
Practice Address - Fax:606-325-3664
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY26553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64265531Medicaid
KY64265531Medicaid
KY1493401Medicare ID - Type UnspecifiedPROVIDER ID