Provider Demographics
NPI:1962296483
Name:COLLINS, KELLY MICHELLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:COLLINS
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-7959
Mailing Address - Country:US
Mailing Address - Phone:864-506-3232
Mailing Address - Fax:
Practice Address - Street 1:2050 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-7959
Practice Address - Country:US
Practice Address - Phone:864-506-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily