Healthcare Provider Details

I. General information

NPI: 1881895118
Provider Name (Legal Business Name): KRISTINA MARIE COLLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 WILLIAMS DR
GEORGETOWN TX
78633-1302
US

IV. Provider business mailing address

4513 WILLIAMS DR
GEORGETOWN TX
78633-1302
US

V. Phone/Fax

Practice location:
  • Phone: 512-930-3909
  • Fax: 512-869-5868
Mailing address:
  • Phone: 512-930-3909
  • Fax: 512-869-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberP8873
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberP8873
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: