Provider Demographics
NPI:1962220616
Name:COLLINS, KEITHEON RAYMONE (PA)
Entity type:Individual
Prefix:MR
First Name:KEITHEON
Middle Name:RAYMONE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:1075 E BETTERAVIA RD # 201
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7023
Mailing Address - Country:US
Mailing Address - Phone:805-621-7714
Mailing Address - Fax:
Practice Address - Street 1:1925 BERRYBROOK DR
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-8403
Practice Address - Country:US
Practice Address - Phone:214-930-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical