Healthcare Provider Details

I. General information

NPI: 1477551844
Provider Name (Legal Business Name): NICOLE PRAY KOLLMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 04/26/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 HOSPITAL DR STE 201
BOLIVIA NC
28422-8665
US

IV. Provider business mailing address

PO BOX 936857
ATLANTA GA
31193-6857
US

V. Phone/Fax

Practice location:
  • Phone: 910-662-9500
  • Fax: 910-662-9501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number900356
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: