Healthcare Provider Details

I. General information

NPI: 1396107587
Provider Name (Legal Business Name): RUTH RENEE HOLLEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S 3RD ST
GIRARD IL
62640-1547
US

IV. Provider business mailing address

20733 N BROAD ST
CARLINVILLE IL
62626-1499
US

V. Phone/Fax

Practice location:
  • Phone: 217-627-2222
  • Fax:
Mailing address:
  • Phone: 217-854-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.014088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: