Provider Demographics
NPI:1245441179
Name:MAYER, HOLLY M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:M
Last Name:MAYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 LEXINGTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8301
Mailing Address - Country:US
Mailing Address - Phone:502-570-0015
Mailing Address - Fax:
Practice Address - Street 1:1150 LEXINGTON RD STE 102
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324
Practice Address - Country:US
Practice Address - Phone:502-570-0015
Practice Address - Fax:502-570-0016
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA373363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant