Provider Demographics
NPI:1316287931
Name:COLLINS, KEVIN CHARLES (RN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHARLES
Last Name:COLLINS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20370 POE SHOLES DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7938
Mailing Address - Country:US
Mailing Address - Phone:541-318-1377
Mailing Address - Fax:
Practice Address - Street 1:20370 POE SHOLES DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7938
Practice Address - Country:US
Practice Address - Phone:541-318-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health