MEDICARE: MRS. HOLLY LYNNE REVLING FNP-BC

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	363LF0000X	Family Nurse Practitioner	123948	WV

General Provider Information

NPI Number	:	1700779964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY LYNNE REVLING FNP-BC

Provider Business Mailing Address
First Line	:	94 W MAIN ST
Second Line	:
City	:	BUCKHANNON
State	:	WV
Zip	:	26201-2284
Country	:	US
Telephone Number	:	304-473-2202
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 W MAIN ST
Second Line	:
City	:	BUCKHANNON
State	:	WV
Zip	:	26201-2284
Country	:	US
Telephone Number	:	304-473-2202
Fax Number	:	304-473-2211

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

Provider Enumeration Date	:	05/29/2025
Last Update Date	:	08/13/2025

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Directions to “ MRS. HOLLY LYNNE REVLING FNP-BC” Practice Location

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