Provider Demographics
NPI:1316474661
Name:COLLARD, KALYN MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:KALYN
Middle Name:MICHELLE
Last Name:COLLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LAKE RD STE 600
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4982
Mailing Address - Country:US
Mailing Address - Phone:979-297-7337
Mailing Address - Fax:979-266-9076
Practice Address - Street 1:210 LAKE RD STE 600
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4982
Practice Address - Country:US
Practice Address - Phone:979-297-7337
Practice Address - Fax:979-266-9076
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10060928208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics