Healthcare Provider Details

I. General information

NPI: 1386622561
Provider Name (Legal Business Name): KIMBERLY MARIE COLLINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY MARIE KESLER MD

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 POCAHONTAS RD
BAKER CITY OR
97814-1464
US

IV. Provider business mailing address

PO BOX 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 541-524-8000
  • Fax: 541-524-7965
Mailing address:
  • Phone: 208-367-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD229544
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2003-0466
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: