MEDICARE: BRYNN KATHRYNE 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	0010-16143	NC

General Provider Information

NPI Number	:	1831987551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYNN KATHRYNE COLLINS

Provider Business Mailing Address
First Line	:	1217 LOST OAK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1056
Country	:	US
Telephone Number	:	704-996-9082
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 LOST OAK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-1056
Country	:	US
Telephone Number	:	704-996-9082
Fax Number	:

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

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	06/02/2026

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