Provider Demographics
NPI:1255495982
Name:BATTAILE, HOLLY RENE' (FNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RENE'
Last Name:BATTAILE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 COUNTY ROAD 312
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-8588
Mailing Address - Country:US
Mailing Address - Phone:817-558-1289
Mailing Address - Fax:
Practice Address - Street 1:800 STELLA MAE DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-6815
Practice Address - Country:US
Practice Address - Phone:877-521-7927
Practice Address - Fax:877-521-7927
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX581424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141679407Medicaid
TXNP0254Medicare PIN