Healthcare Provider Details

I. General information

NPI: 1427014901
Provider Name (Legal Business Name): MARYLYNN HOLLAND RN, CPNP, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 S 70TH ST
FORT SMITH AR
72903-5050
US

IV. Provider business mailing address

3222 S 70TH ST
FORT SMITH AR
72903-5050
US

V. Phone/Fax

Practice location:
  • Phone: 479-785-2825
  • Fax: 479-782-6630
Mailing address:
  • Phone: 479-785-2825
  • Fax: 479-782-6630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberP00170
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: