Provider Demographics
NPI:1245739127
Name:WILLIAMS, HOLLIE MARIE (APRN)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-1717
Mailing Address - Country:US
Mailing Address - Phone:785-741-3633
Mailing Address - Fax:
Practice Address - Street 1:3349B THRASHER RD
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:KS
Practice Address - Zip Code:66094-4005
Practice Address - Country:US
Practice Address - Phone:785-595-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78048363LF0000X
KS53-780048-082363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201207970AMedicaid