Provider Demographics
NPI:1932694288
Name:HILLIS, HOLLEY L (PMHNP)
Entity Type:Individual
Prefix:
First Name:HOLLEY
Middle Name:L
Last Name:HILLIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:HOLLEY
Other - Middle Name:L
Other - Last Name:HILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-2150
Mailing Address - Country:US
Mailing Address - Phone:765-464-4626
Mailing Address - Fax:
Practice Address - Street 1:333 SE 2ND AVE STE 2000
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2185
Practice Address - Country:US
Practice Address - Phone:786-490-7824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008110A363L00000X, 363LP0808X, 363LP0808X
HIAPRN-2823363LP0808X
FL11004074363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner