Healthcare Provider Details

I. General information

NPI: 1902154727
Provider Name (Legal Business Name): HOLLY NESMITH MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15854 JACKSON CREEK PKWY UNIT 120
MONUMENT CO
80132-8663
US

IV. Provider business mailing address

15854 JACKSON CREEK PKWY UNIT 120
MONUMENT CO
80132-8663
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-9930
  • Fax: 719-365-7667
Mailing address:
  • Phone: 719-364-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00990461
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: