=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639608813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEONDREA DEANNA STEWART COLLINS FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2017
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6501 DOGWOOD VIEW PKWY
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39213-7857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-899-3310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 297 HIGHWAY 51 STE D
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-3423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-790-0922
-----------------------------------------------------
Fax | 601-790-0923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 886015
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------