Provider Demographics
NPI:1194377325
Name:MAGILLIGAN, COLLIN PATRICK (FNP)
Entity type:Individual
Prefix:MR
First Name:COLLIN
Middle Name:PATRICK
Last Name:MAGILLIGAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 N NEW BALLAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6848
Mailing Address - Country:US
Mailing Address - Phone:314-266-2066
Mailing Address - Fax:314-266-2069
Practice Address - Street 1:425 N NEW BALLAS RD STE 230
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6848
Practice Address - Country:US
Practice Address - Phone:314-266-2066
Practice Address - Fax:314-266-2066
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019022744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420080147Medicaid