Provider Demographics
NPI:1053392712
Name:COLLINS, LETHIA ANNETTE (FNP, RNFA)
Entity type:Individual
Prefix:MRS
First Name:LETHIA
Middle Name:ANNETTE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:FNP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10017 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9207
Mailing Address - Country:US
Mailing Address - Phone:812-246-8710
Mailing Address - Fax:812-949-7179
Practice Address - Street 1:10017 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-9207
Practice Address - Country:US
Practice Address - Phone:812-246-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7100612A363LF0000X
IN71000612A163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200219360BMedicaid
IN200219360BMedicaid