Provider Demographics
NPI:1598079600
Name:JANET HOLLEY, CRNP PC
Entity Type:Organization
Organization Name:JANET HOLLEY, CRNP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-486-2743
Mailing Address - Street 1:42030 HIGHWAY 195 STE D
Mailing Address - Street 2:P O BOX 970
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-7054
Mailing Address - Country:US
Mailing Address - Phone:205-486-2743
Mailing Address - Fax:205-486-4343
Practice Address - Street 1:42030 HIGHWAY 195
Practice Address - Street 2:SUITE D
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7054
Practice Address - Country:US
Practice Address - Phone:205-486-2743
Practice Address - Fax:205-486-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-069794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00431210OtherRR MEDICARE
AL891017150Medicaid
AL051540283Medicare PIN