Healthcare Provider Details

I. General information

NPI: 1922037811
Provider Name (Legal Business Name): HOLLY NICOLE MYLES N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY NICOLE VICK N.P.

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RANCH RD
WEST LAFAYETTE IN
47906-9789
US

IV. Provider business mailing address

2401 RANCH RD
WEST LAFAYETTE IN
47906-9789
US

V. Phone/Fax

Practice location:
  • Phone: 765-412-4478
  • Fax:
Mailing address:
  • Phone: 765-412-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71002110A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71002110A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: