MEDICARE: MISS CHARNELL HOLLIS NP

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	208VP0014X	Interventional Pain Medicine Physician	1096464	TX
2	363LF0000X	Family Nurse Practitioner	1096464	TX

General Provider Information

NPI Number	:	1922883883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHARNELL HOLLIS NP

Provider Business Mailing Address
First Line	:	PO BOX 35629
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-0629
Country	:	US
Telephone Number	:	214-424-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 FAIRMONT PKWY
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-3324
Country	:	US
Telephone Number	:	832-456-8434
Fax Number	:

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

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	01/30/2024

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