Healthcare Provider Details

I. General information

NPI: 1992184030
Provider Name (Legal Business Name): TYLER B. HOLLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 NEW SHEPHERDSVILLE RD
BARDSTOWN KY
40004-8040
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 502-350-5492
  • Fax: 502-350-5822
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number53693
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: