Healthcare Provider Details

I. General information

NPI: 1447162144
Provider Name (Legal Business Name): JEREMIAH COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5429 PAYNE CT
SHAWNEE KS
66226-3905
US

IV. Provider business mailing address

5429 PAYNE CT
SHAWNEE KS
66226-3905
US

V. Phone/Fax

Practice location:
  • Phone: 417-231-7264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: