Ethan Collins, FNP
Individual provider Active NPI Family Nurse Practitioner · Coeburn, VA
NPI 1336713148 · NPPES record last updated Feb 23, 2022
Key facts
- NPI
- 1336713148
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 0024183385 (VA)
- Practice address
- 208W Front Street
Coeburn, VA 24230 - Phone
- (276) 455-5556
- NPI assigned
- May 17, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Appalachian Center for Excellence in Healthcare Inc
Practice addresses (Care Compare)
116 Centre Ave NE
Coeburn, VA 24230-4023
Phone (276) 455-5556
Hospital & facility affiliations
- Lonesome Pine Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220512001441 | VA | Practitioner - Nurse Practitioner | 3274910260 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0001238326 | VA | MD | General Practice Registered Nurse |
| 0024183385 | VA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Appalachian Center for Excellence and Healthcare, Inc. | Current |
Accepting new patients | |
| Appalachian Center for Excellence in Healthcare Inc | Family | Current |
Accepting new patients |
Locations
927 Happy Valley Dr
Clintwood, VA 24228
Phone (276) 455-5556
116 Centre Ave NE
Coeburn, VA 24230
Phone (276) 231-0039
5626 Patriot Dr
Wise, VA 24293
Phone (276) 328-8850
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 0001238326 | VA | |
| Family Nurse Practitioner | 363LF0000X | 0024183385 | VA | Yes |
Addresses
Primary practice location
208W Front Street
Coeburn, VA 24230
Mailing address
PO Box 90
Coeburn, VA 24230-0090
Phone (276) 455-5556
Other providers in Coeburn, VA
- Scott Brooks
- Click Care LLC
- Coeburn Clinic, Inc
- Coeburn Taxi Service, Inc.
- Collins Facilitation Services
- Community Physicians Services Corporation
- Braxton Tyler Cordill
- Cross Roads Point, Inc.
- Teri Dahley
- Patricia Ann Dearmen
All providers in Coeburn, VA · Family Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.