Individual provider Active NPI

Kyla Marie Collins, NP

  • Nurse Practitioner
  • Southbridge, MA
National Provider Identifier
1235960683
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN2313655 Issued in MA
Practice address
222 Main St
Southbridge, MA 01550-2593
Phone
(508) 765-7711
NPI assigned
Aug 8, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN2313655 MA Primary

Addresses

Primary practice location

222 Main St
Southbridge, MA 01550-2593

Mailing address

54 Alan Ave
Pascoag, RI 02859-2800
Phone (508) 579-0117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241127002169 RI Practitioner - Nurse Practitioner 5597290551 Practice locations: Pascoag, RI
I20250409003438 MA Practitioner - Nurse Practitioner 5597290551 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Mass Dermatology, PCGroup PAC ID 7416010434, 3 clinicians

Practice addresses (Care Compare)

222 Main St
Southbridge, MA 01550-2593
Phone (508) 765-7711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN2313655MAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Mass Dermatology PC CurrentSince Jan 12, 2025 Accepting new patients

Locations

222 Main St
Southbridge, MA 01550
Phone (508) 764-2758

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1235960683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 ALAN AVE",
            "city": "PASCOAG",
            "state": "RI",
            "postal_code": "028592800",
            "telephone_number": "508-579-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 MAIN ST",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015502593",
            "telephone_number": "508-765-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "KYLA",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-08",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2313655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbridge, MA

Sources for this page

Verify at the official NPI Registry.