Healthcare Provider Details

I. General information

NPI: 1558273227
Provider Name (Legal Business Name): KYLIE LYNN HOLLAND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 87TH AVE FL A3
MERRILLVILLE IN
46410-7355
US

IV. Provider business mailing address

101 E 87TH AVE FL A3
MERRILLVILLE IN
46410-7355
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-6670
  • Fax:
Mailing address:
  • Phone: 219-738-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10005492A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: