Provider Demographics
NPI:1306463526
Name:COLLINS, KAITLYN ANN (PA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ANN
Other - Last Name:PARKINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:925 E POLSTON AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9049
Practice Address - Country:US
Practice Address - Phone:208-618-0787
Practice Address - Fax:844-807-3782
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant