Healthcare Provider Details

I. General information

NPI: 1932694288
Provider Name (Legal Business Name): HOLLEY L HILLIS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLEY L ROGERS NP

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 N PENN ST STE 104
CARMEL IN
46032-4694
US

IV. Provider business mailing address

115 W 3RD ST
PERU IN
46970-2150
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone: 765-464-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11004074
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71008110A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71008110A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-2823
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: