Provider Demographics
NPI:1578569844
Name:HINDS, HOLLY (CRNA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HINDS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21090 NE MEERS PORTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:OK
Mailing Address - Zip Code:73541-3263
Mailing Address - Country:US
Mailing Address - Phone:580-480-5063
Mailing Address - Fax:
Practice Address - Street 1:5602 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9699
Practice Address - Country:US
Practice Address - Phone:580-531-4727
Practice Address - Fax:580-531-6430
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0059134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100782500CMedicaid
OK100782500CMedicaid
OK239704003Medicare ID - Type Unspecified