Provider Demographics
NPI:1942737978
Name:COLLINS, KATHLEEN ADELE (DO, MBA)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ADELE
Last Name:COLLINS
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Gender:F
Credentials:DO, MBA
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Mailing Address - Street 1:77 W FOREST AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1483
Mailing Address - Country:US
Mailing Address - Phone:928-773-2222
Mailing Address - Fax:928-773-2598
Practice Address - Street 1:77 W FOREST AVE STE 201
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1483
Practice Address - Country:US
Practice Address - Phone:928-773-2222
Practice Address - Fax:928-773-2598
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2022-06-29
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Provider Licenses
StateLicense IDTaxonomies
AZ009521208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery