Healthcare Provider Details

I. General information

NPI: 1326978107
Provider Name (Legal Business Name): JACQUELYN COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 N EMERY ST
INDEPENDENCE MO
64050-1981
US

IV. Provider business mailing address

9608 MAYWOOD AVE
KANSAS CITY MO
64134-2336
US

V. Phone/Fax

Practice location:
  • Phone: 678-914-1439
  • Fax:
Mailing address:
  • Phone: 816-678-5048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: