Provider Demographics
NPI:1770018525
Name:HOLLIS, DONNA (APRN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:HOLLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:700 MARTIN L KING AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420
Mailing Address - Country:US
Mailing Address - Phone:270-826-4800
Mailing Address - Fax:
Practice Address - Street 1:700 MARTIN L KING AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4242
Practice Address - Country:US
Practice Address - Phone:270-826-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily