Provider Demographics
NPI:1437734837
Name:BARE, HOLLY RENAE (LPN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RENAE
Last Name:BARE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 QUAIL RUN RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-8714
Mailing Address - Country:US
Mailing Address - Phone:903-771-9993
Mailing Address - Fax:
Practice Address - Street 1:1733 TEXOMA PKWY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2613
Practice Address - Country:US
Practice Address - Phone:903-893-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345431164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse