Provider Demographics
NPI:1154657625
Name:HOLLIS, KATRICE HOLLIS (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KATRICE
Middle Name:HOLLIS
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:KATRICE
Other - Middle Name:DIONNE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 70365
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107
Mailing Address - Country:US
Mailing Address - Phone:334-420-5001
Mailing Address - Fax:334-420-0146
Practice Address - Street 1:1845 CHERRY STREET
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107
Practice Address - Country:US
Practice Address - Phone:334-420-5001
Practice Address - Fax:334-420-0146
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA186422363LF0000X
AL1-173899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001557400Medicaid