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1821443524 NPI number — JESSICA COLLINS DO

NPI Number: 1821443524
Health Care Provider/Practitioner: JESSICA COLLINS DO

Information about “1821443524” NPI (JESSICA COLLINS DO) exists in 1821443524 in HTML format HTML  |  1821443524 in plain Text format TXT  |  1821443524 in PDF (Portable Document Format) PDF  |  1821443524 in an XML format XML  formats.

NPI Number : 1821443524 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821443524",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COLLINS",
    "FirstName": "JESSICA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 2379",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ASHLAND",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "41105-2379",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2930 CARTER AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ASHLAND",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "41101-1943",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "606-324-1483",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/01/2016",
    "LastUpdateDate": "09/21/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "09/09/2021",
    "NPIReactivationDate": "09/14/2021",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "70219",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207ND0101X",
          "TaxonomyName": "MOHS-Micrographic Surgery Physician",
          "LicenseNumber": "10929348-1204",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "C3394",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207NS0135X",
          "TaxonomyName": "Procedural Dermatology Physician",
          "LicenseNumber": "10929348-1204",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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