Healthcare Provider Details

I. General information

NPI: 1558295048
Provider Name (Legal Business Name): HOLLY K HAIR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LEXINGTON RD
VERSAILLES KY
40383-1738
US

IV. Provider business mailing address

102 WHISPER DR
SUMMERVILLE SC
29485-9209
US

V. Phone/Fax

Practice location:
  • Phone: 859-251-4700
  • Fax:
Mailing address:
  • Phone: 843-908-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number223861
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: