Provider Demographics
NPI:1225161615
Name:HOLLIS, LINDA S (RN, ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1845 FAIRMOUNT STREET
Mailing Address - Street 2:209 AHLBERG HALL ROOM 209
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67620-0092
Mailing Address - Country:US
Mailing Address - Phone:316-978-3620
Mailing Address - Fax:316-978-3517
Practice Address - Street 1:1845 FAIRMOUNT STREET
Practice Address - Street 2:209 AHLBERG HALL ROOM 209
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67620-0092
Practice Address - Country:US
Practice Address - Phone:316-978-3620
Practice Address - Fax:316-978-3517
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS53-44012-081363LF0000X
KS44012363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10368460AMedicaid
KS110035OtherBCBS OF KS GROUP PROVIDER
KS161387OtherBCBS OF KS INDIVIDUAL ID#