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General NPI Number Information
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NPI Number | 1962296483
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Entity Type | Individual
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Provider Name | KELLY MICHELLE COLLINS NP
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Gender | Female
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 136 STONEMARK LN STE 100C
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City | COLUMBIA
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State | SC
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Zip | 29210-3881
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Country | US
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Telephone | 888-704-4661
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Fax | 888-239-2595
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Provider Business Mailing Address
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Address Line | 2050 SUNSET DR
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City | SENECA
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State | SC
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Zip | 29672-7959
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Country | US
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Telephone | 864-506-3232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 30221
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License Number State | SC
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