Provider Demographics
NPI:1326193087
Name:WEST, HOLLY A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:A
Last Name:WEST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:A
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1145
Mailing Address - Country:US
Mailing Address - Phone:409-772-3048
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1145
Practice Address - Country:US
Practice Address - Phone:409-772-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04659363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q61701Medicare UPIN
8G2742Medicare ID - Type UnspecifiedMDACC MEDICARE