Provider Demographics
NPI:1932571262
Name:MEDLEN, HOLLY (APRN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MEDLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1604 INDUSTRIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-9528
Mailing Address - Country:US
Mailing Address - Phone:913-294-9223
Mailing Address - Fax:
Practice Address - Street 1:1604 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-9528
Practice Address - Country:US
Practice Address - Phone:913-294-9223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5377008041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily