MEDICARE: JASON COLLINS & ASSOCIATES LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1575	OTHER	LA	STATE LICENSE

General Provider Information

NPI Number	:	1801323845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON COLLINS & ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	120 GENNA LN
Second Line	:
City	:	YOUNGSVILLE
State	:	LA
Zip	:	70592-6269
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	847 STEWART ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-8539
Country	:	US
Telephone Number	:	337-237-4673
Fax Number	:	337-237-4674

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. KRISTI S ANDREW
Credential	:
Telephone Number	:	504-491-1807

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/22/2017

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