Provider Demographics
NPI:1245679422
Name:COLLINS, NATHANIEL DAVID (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:DAVID
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7473C HWY 22
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-8514
Mailing Address - Country:US
Mailing Address - Phone:910-215-5100
Mailing Address - Fax:910-215-5114
Practice Address - Street 1:7473C HWY 22
Practice Address - Street 2:
Practice Address - City:WHISPERING PINES
Practice Address - State:NC
Practice Address - Zip Code:28327-8514
Practice Address - Country:US
Practice Address - Phone:910-215-5100
Practice Address - Fax:910-215-5114
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV64409363LF0000X
NC5010056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026809Medicaid
OH0089487Medicaid
OH0089487Medicaid