Provider Demographics
NPI:1699730549
Name:COLLINS, KEVIN JEROME (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JEROME
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:J
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PA
Mailing Address - Street 1:3401 SPRINGHILL DRIVE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2942
Mailing Address - Country:US
Mailing Address - Phone:501-945-1888
Mailing Address - Fax:501-945-4102
Practice Address - Street 1:3401 SPRINGHILL DRIVE
Practice Address - Street 2:SUITE 460
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2942
Practice Address - Country:US
Practice Address - Phone:501-945-1888
Practice Address - Fax:501-945-4102
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8372208100000X
OH35060536208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123742001Medicaid
ARN8372OtherOTHER LICESE NUMBER
ARN8372OtherOTHER LICESE NUMBER
BC2549989OtherDEA
F09119Medicare UPIN