Provider Demographics
NPI:1215595020
Name:WORKMAN, HOLLY MARIE
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RYANS WAY
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-7062
Mailing Address - Country:US
Mailing Address - Phone:502-514-7147
Mailing Address - Fax:
Practice Address - Street 1:125 RYANS WAY
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-7062
Practice Address - Country:US
Practice Address - Phone:502-514-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4286OtherCERTIFICATION