Individual
JENNIFER ANN KOLLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
220 CASTLETON CIR, BOILING SPRINGS, SC 29316-6230
(704) 773-5896
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
22284
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP5525
—
SC
01
—
SCD922J577
MEDICARE PIN
SC
01
—
SCG8286067
MEDICARE PIN
SC
01
—
SCG8286084
MEDICARE PIN
SC
Enumeration date
10/04/2018
Last updated
01/29/2021
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