Provider Demographics
NPI:1295016822
Name:PARKER, HOLLY S (RN CPNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:S
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN CPNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:S
Other - Last Name:LIEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN CPNP
Mailing Address - Street 1:2400 CEDAR BEND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5378
Mailing Address - Country:US
Mailing Address - Phone:512-901-4031
Mailing Address - Fax:512-901-3937
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4031
Practice Address - Fax:512-901-3937
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640897363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145311002Medicaid
TX145311002Medicaid