Provider Demographics
NPI:1629586953
Name:HAMILTON, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:TX
Mailing Address - Zip Code:75152-9638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:691 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:TX
Practice Address - Zip Code:75152-9638
Practice Address - Country:US
Practice Address - Phone:817-517-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX612070163W00000X
TXAP136310363LA2200X
TXAP36310363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health