Provider Demographics
NPI:1154101657
Name:COLLETT, MIKAYLA H (APRN)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:H
Last Name:COLLETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MEMORIAL DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-9157
Mailing Address - Country:US
Mailing Address - Phone:606-599-0169
Mailing Address - Fax:606-599-0297
Practice Address - Street 1:515 MEMORIAL DR STE 3
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-9157
Practice Address - Country:US
Practice Address - Phone:606-599-0169
Practice Address - Fax:606-599-0297
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4009969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily