Provider Demographics
NPI:1700175106
Name:BEALL, HOLLI KATHLEEN (APN)
Entity type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:KATHLEEN
Last Name:BEALL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:HOLLI
Other - Middle Name:KATHLEEN
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:P O BOX 850849
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0849
Mailing Address - Country:US
Mailing Address - Phone:251-343-5004
Mailing Address - Fax:251-343-8383
Practice Address - Street 1:124 S UNIVERSITY BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3078
Practice Address - Country:US
Practice Address - Phone:251-343-5004
Practice Address - Fax:251-343-8383
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03525363LA2100X
AL1-144789363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care