Provider Demographics
NPI:1962239392
Name:COLLINS, KEVA KERRY (WHNP, DNP)
Entity type:Individual
Prefix:
First Name:KEVA
Middle Name:KERRY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:WHNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5704
Mailing Address - Country:US
Mailing Address - Phone:347-834-5944
Mailing Address - Fax:
Practice Address - Street 1:592 E 42ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5704
Practice Address - Country:US
Practice Address - Phone:347-834-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF421746-01363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty