Basic Information
Provider Information
NPI: 1972151454
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOLLIS
FirstName: APRIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 23229
Address2:  
City: OWENSBORO
State: KY
PostalCode: 423043229
CountryCode: US
TelephoneNumber: 2706881330
FaxNumber: 2706881338
Practice Location
Address1: 2025 W EVERLY BROTHERS BLVD
Address2:  
City: POWDERLY
State: KY
PostalCode: 423675401
CountryCode: US
TelephoneNumber: 2703772600
FaxNumber: 2703772610
Other Information
ProviderEnumerationDate: 08/28/2019
LastUpdateDate: 08/28/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X3013712KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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