=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326794850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BILLIE R COLLIER RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2022
-----------------------------------------------------
Last Update Date | 02/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 413 W TYLER AVE
-----------------------------------------------------
City | WEST MEMPHIS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72301-4149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-735-2737
-----------------------------------------------------
Fax | 870-551-3724
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2192
-----------------------------------------------------
City | FORREST CITY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72336-2192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-735-2737
-----------------------------------------------------
Fax | 870-551-3724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 854392
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------