Provider Demographics
NPI:1053958793
Name:COLLINS RATLIFF, ANDREA LILLIAN
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LILLIAN
Last Name:COLLINS RATLIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ANDERSON CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3200
Mailing Address - Country:US
Mailing Address - Phone:606-670-2165
Mailing Address - Fax:
Practice Address - Street 1:4835 POPLAR LEVEL RD STE 110
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2906
Practice Address - Country:US
Practice Address - Phone:855-591-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker