Healthcare Provider Details

I. General information

NPI: 1518223247
Provider Name (Legal Business Name): MRS. VERONICA COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 POPLAR AVE STE 213
MEMPHIS TN
38117-4432
US

IV. Provider business mailing address

4646 POPLAR AVE STE 213
MEMPHIS TN
38117-4432
US

V. Phone/Fax

Practice location:
  • Phone: 901-474-7166
  • Fax: 901-474-7166
Mailing address:
  • Phone: 901-474-7166
  • Fax: 901-474-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1000000010608
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: