Provider Demographics
NPI:1568541944
Name:PARIS, HOLLY KAY (PA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:KAY
Last Name:PARIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 COBB ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2542
Mailing Address - Country:US
Mailing Address - Phone:231-775-8814
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:440 COBB ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601
Practice Address - Country:US
Practice Address - Phone:231-775-8814
Practice Address - Fax:619-906-4564
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003926363A00000X
CA54150363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P17980011Medicare PIN