Healthcare Provider Details

I. General information

NPI: 1639781396
Provider Name (Legal Business Name): VICTORIA HOLLIS DNP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 BLOCK ST
MARION AR
72364-1956
US

IV. Provider business mailing address

623 N DELTA DR
MARION AR
72364-2686
US

V. Phone/Fax

Practice location:
  • Phone: 870-559-2314
  • Fax:
Mailing address:
  • Phone: 901-552-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number212862
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: