Provider Demographics
NPI:1073265864
Name:SHOULDERS, HOLLY MARIE (RN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:SHOULDERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-3245
Mailing Address - Country:US
Mailing Address - Phone:812-598-1218
Mailing Address - Fax:
Practice Address - Street 1:400 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-2800
Practice Address - Country:US
Practice Address - Phone:812-598-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1110152163WF0300X
KY3017503363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WF0300XNursing Service ProvidersRegistered NurseFlight