Provider Demographics
NPI:1124463914
Name:COLLINS, AGNES MCKOWEN (PA)
Entity type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:MCKOWEN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 487
Mailing Address - Street 2:
Mailing Address - City:ST. FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775
Mailing Address - Country:US
Mailing Address - Phone:225-635-5848
Mailing Address - Fax:225-635-5847
Practice Address - Street 1:5326 OAK ST.
Practice Address - Street 2:
Practice Address - City:ST. FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775
Practice Address - Country:US
Practice Address - Phone:225-635-5848
Practice Address - Fax:225-635-5847
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL881363AM0700X
LA320653363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical