Provider Demographics
NPI:1952940991
Name:COLLINS, WILLIAM SCOTT
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SCOTT
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 REDBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3151
Mailing Address - Country:US
Mailing Address - Phone:937-867-5123
Mailing Address - Fax:
Practice Address - Street 1:1111 REDBLUFF DR
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3151
Practice Address - Country:US
Practice Address - Phone:937-867-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily