Provider Demographics
NPI:1194198135
Name:HATTAWAY, HOLLY KATHRYN (CRNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:KATHRYN
Last Name:HATTAWAY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1719 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1719 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0001
Practice Address - Country:US
Practice Address - Phone:205-975-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-136564363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health