Provider Demographics
NPI:1740459718
Name:HOLLIS, KEVIN EUGENE (CMA)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:EUGENE
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:CLAY CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62824-1012
Mailing Address - Country:US
Mailing Address - Phone:618-317-0472
Mailing Address - Fax:
Practice Address - Street 1:12612 CHALLENGER PKWY STE 365
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-2784
Practice Address - Country:US
Practice Address - Phone:407-306-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program