Basic Information
Provider Information | |||||||||
NPI: | 1336475557 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COLLINS | ||||||||
FirstName: | JAMIE | ||||||||
MiddleName: | LEIGH | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SCHOONOVER | ||||||||
OtherFirstName: | JAMIE | ||||||||
OtherMiddleName: | LEIGH | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA-C | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1513 HARRISON AVE | ||||||||
Address2: | SUITE 18 | ||||||||
City: | ELKINS | ||||||||
State: | WV | ||||||||
PostalCode: | 262413356 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3046370180 | ||||||||
FaxNumber: | 3046371004 | ||||||||
Practice Location | |||||||||
Address1: | 3 HEALTHCARE DR | ||||||||
Address2: |   | ||||||||
City: | PHILIPPI | ||||||||
State: | WV | ||||||||
PostalCode: | 264169405 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3044570063 | ||||||||
FaxNumber: | 3044574011 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/22/2009 | ||||||||
LastUpdateDate: | 03/06/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/06/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 479 | WV | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | WV 479 | 01 | WV | WEST VIRGINIA LICENSE | OTHER |