MEDICARE: KRYSTAL COLLINS APRN

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	363LF0000X	Family Nurse Practitioner	121628	AR

General Provider Information

NPI Number	:	1780230375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL COLLINS APRN

Provider Business Mailing Address
First Line	:	9800 BAPTIST HEALTH DR STE 600
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6244
Country	:	US
Telephone Number	:	502-221-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	9800 BAPTIST HEALTH DR STE 600
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6244
Country	:	US
Telephone Number	:	501-221-0123
Fax Number	:

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

Provider Enumeration Date	:	08/10/2019
Last Update Date	:	09/01/2019

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