Healthcare Provider Details

I. General information

NPI: 1427875442
Provider Name (Legal Business Name): WHITNEY KAY COLLINSWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 9TH ST
SANTA MONICA CA
90404-4501
US

IV. Provider business mailing address

909 PICO BLVD
SANTA MONICA CA
90405-1326
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6200
  • Fax:
Mailing address:
  • Phone: 866-452-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: