1578855102 NPI number — MRS. CHRISTA SHEREE COLLINS M.S. CFY-SLP

Table of content: MRS. CHRISTA SHEREE COLLINS M.S. CFY-SLP (NPI 1578855102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578855102 NPI number — MRS. CHRISTA SHEREE COLLINS M.S. CFY-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
CHRISTA
Provider Middle Name:
SHEREE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CFY-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROTTS
Provider Other First Name:
CHRISTA
Provider Other Middle Name:
SHEREE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578855102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONES
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73049-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-397-3550
Provider Business Mailing Address Fax Number:
405-399-2350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 MIDTOWN PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73130-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-397-3550
Provider Business Practice Location Address Fax Number:
405-399-2350
Provider Enumeration Date:
05/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  3910 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200438530A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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