Healthcare Provider Details

I. General information

NPI: 1316675523
Provider Name (Legal Business Name): MISS HOLLY ELISABETH CROUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3971 LITTLE SAVANNAH ROAD
CULLOWHEE NC
28723
US

IV. Provider business mailing address

70 WESTSIDE DR APT 308A
CULLOWHEE NC
28723-1170
US

V. Phone/Fax

Practice location:
  • Phone: 828-227-7271
  • Fax:
Mailing address:
  • Phone: 828-506-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: