Healthcare Provider Details

I. General information

NPI: 1922982875
Provider Name (Legal Business Name): JAMES COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 BATTERY PARK DR
GLENDALE KY
42740-8800
US

IV. Provider business mailing address

305 N 5TH ST
BARDSTOWN KY
40004-1405
US

V. Phone/Fax

Practice location:
  • Phone: 901-451-4904
  • Fax:
Mailing address:
  • Phone: 502-682-8762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number1153268
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: