Provider Demographics
NPI:1275030017
Name:DODD, HOLLY MILES (MSN, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MILES
Last Name:DODD
Suffix:
Gender:F
Credentials:MSN, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:8300 COLLEGE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2813
Mailing Address - Country:US
Mailing Address - Phone:913-945-1277
Mailing Address - Fax:
Practice Address - Street 1:8300 COLLEGE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2813
Practice Address - Country:US
Practice Address - Phone:913-945-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-148365-012163W00000X
KS53-78702-012363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse