Provider Demographics
NPI:1952598401
Name:HINKLE, HOLLY K (NP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:K
Last Name:HINKLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 E HOLLISTER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1784
Mailing Address - Country:US
Mailing Address - Phone:513-559-3412
Mailing Address - Fax:513-559-3419
Practice Address - Street 1:47 E HOLLISTER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1784
Practice Address - Country:US
Practice Address - Phone:513-559-3412
Practice Address - Fax:513-559-3419
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28140549363L00000X
OHCOA07974-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01377008OtherAMERIGROUP
OH311380939069OtherCARESOURCE
OH2522818OtherMOLINA
OH2522818Medicaid