Provider Demographics
NPI:1952600066
Name:COLLINS, KATIE L (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:L
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2394
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8455
Mailing Address - Country:US
Mailing Address - Phone:360-200-6736
Mailing Address - Fax:360-807-4160
Practice Address - Street 1:1131 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3830
Practice Address - Country:US
Practice Address - Phone:360-998-3050
Practice Address - Fax:360-200-6736
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60290488163W00000X
WAAP61618628363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse