MEDICARE: KATIE RHEA COLLINS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA3990	TN

General Provider Information

NPI Number	:	1689219552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE RHEA COLLINS PA-C

Provider Business Mailing Address
First Line	:	2400 DENSO DR
Second Line	:
City	:	ATHENS
State	:	TN
Zip	:	37303-7835
Country	:	US
Telephone Number	:	423-745-0303
Fax Number	:	423-745-0306

Provider Business Practice Location Address
First Line	:	2400 DENSO DR
Second Line	:
City	:	ATHENS
State	:	TN
Zip	:	37303-7835
Country	:	US
Telephone Number	:	423-745-0303
Fax Number	:	423-745-0306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	09/02/2020

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