Provider Demographics
NPI:1922539048
Name:HOLLIS, SARAH RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:RUTH
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:RUTH
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:502-732-6956
Mailing Address - Fax:502-732-8219
Practice Address - Street 1:205 MARWILL DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-1500
Practice Address - Country:US
Practice Address - Phone:502-732-6956
Practice Address - Fax:502-732-8219
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53832207Q00000X
KYPENDING207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK328361OtherMEDICARE EFFECT 10/25/22
KY7100677750Medicaid