Provider Demographics
NPI:1720102312
Name:COLLINS, WILLIAM JOSEPH (APRN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:COLLINS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4100
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-4100
Mailing Address - Country:US
Mailing Address - Phone:606-776-6309
Mailing Address - Fax:606-776-6309
Practice Address - Street 1:3042 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-9136
Practice Address - Country:US
Practice Address - Phone:606-776-6309
Practice Address - Fax:606-363-0141
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006516363LP0808X
KY3005507363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
50704000OtherMAGELLAN MIS GROUP #
KY000000640353OtherANTHEM PIN
KY7100113670Medicaid
000000056294OtherGROUP ANTHEM #
CK2274OtherKY RR MEDICARE GROUP #
KYP00793789OtherRR MEDICARE
KY78903689Medicaid
1063415297OtherMD GROUP NPI
6764OtherKY GROUP MEDICARE #
KYP00793789OtherRAILROAD MEDICARE
1487872636OtherARNP GROUP NPI #
KY2444451000OtherPASSPORT GROUP #
KYP00793789OtherRAILROAD MEDICARE