Provider Demographics
NPI:1346291994
Name:MCCORMICK, HOLLY A (APRN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:A
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1724
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211
Mailing Address - Country:US
Mailing Address - Phone:270-522-0898
Mailing Address - Fax:270-522-5636
Practice Address - Street 1:249 MAIN ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-9154
Practice Address - Country:US
Practice Address - Phone:270-206-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4005P363LF0000X
KY3004005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78010816Medicaid
KYQ01245Medicare UPIN
KY1511205Medicare ID - Type Unspecified