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NPI Code Detail

MEDICARE: MRS. KELSEY MARIE COLLINS

MEDICARE: MRS. KELSEY MARIE COLLINS
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
1163WC0200XCritical Care Medicine Registered Nurse95139914CA
2367500000XCertified Registered Nurse Anesthetist31054SC
3367500000XCertified Registered Nurse Anesthetist95002550CA

General Provider Information

NPI Number : 1720859267
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELSEY MARIE COLLINS
Provider Business Mailing Address
First Line : PO BOX 603484
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-3484
Country : US
Telephone Number : 803-454-2600
Fax Number : 803-765-1732
Provider Business Practice Location Address
First Line : 2095 HENRY TECKLENBURG DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5733
Country : US
Telephone Number : 843-402-1436
Fax Number : 843-402-1833
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2024
Last Update Date : 03/18/2026

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