Provider Demographics
NPI:1104668813
Name:COLLINS, MELODY JOY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:JOY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22266 HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051-8618
Mailing Address - Country:US
Mailing Address - Phone:205-669-3138
Mailing Address - Fax:
Practice Address - Street 1:22266 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-8618
Practice Address - Country:US
Practice Address - Phone:205-669-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine