Provider Demographics
NPI:1255865010
Name:KING-STEVENS, HOLLY (DO)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:KING-STEVENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BELLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-1500
Mailing Address - Country:US
Mailing Address - Phone:251-809-3140
Mailing Address - Fax:251-809-3145
Practice Address - Street 1:1121 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1500
Practice Address - Country:US
Practice Address - Phone:251-809-3140
Practice Address - Fax:251-809-3145
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.2366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL512-47757OtherBCBS OF AL
AL256043Medicaid