Provider Demographics
NPI:1336012442
Name:PROKOP, HOLLY (CHW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:PROKOP
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 STATE HWY 119
Mailing Address - Street 2:
Mailing Address - City:ANTON CHICO
Mailing Address - State:NM
Mailing Address - Zip Code:87711
Mailing Address - Country:US
Mailing Address - Phone:575-472-8032
Mailing Address - Fax:877-651-0289
Practice Address - Street 1:1753 HWY 119
Practice Address - Street 2:
Practice Address - City:ANTON CHICO
Practice Address - State:NM
Practice Address - Zip Code:87711
Practice Address - Country:US
Practice Address - Phone:575-472-8032
Practice Address - Fax:877-651-0289
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker