Healthcare Provider Details

I. General information

NPI: 1134667793
Provider Name (Legal Business Name): KEVIN COLLINS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 N WATER ST
DECATUR IL
62526-2472
US

IV. Provider business mailing address

3131 N WATER ST
DECATUR IL
62526-2472
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-5320
  • Fax: 217-876-5865
Mailing address:
  • Phone: 217-876-5320
  • Fax: 217-876-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015484
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: