MEDICARE: HOLLY MICHELLE RICH APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R0120229	OK

General Provider Information

NPI Number	:	1144165119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY MICHELLE RICH APRN-CNP

Provider Business Mailing Address
First Line	:	15209 MISTY PARK DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-9694
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15209 MISTY PARK DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-9694
Country	:	US
Telephone Number	:	918-440-1675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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