Healthcare Provider Details

I. General information

NPI: 1750145165
Provider Name (Legal Business Name): MRS. BONNEY COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2969 CURRAN DR N # 200
JACKSON MS
39216-4121
US

IV. Provider business mailing address

2969 CURRAN DR N # 200
JACKSON MS
39216-4121
US

V. Phone/Fax

Practice location:
  • Phone: 601-974-5600
  • Fax:
Mailing address:
  • Phone: 601-974-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number906054
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: