Healthcare Provider Details

I. General information

NPI: 1538093190
Provider Name (Legal Business Name): CAROL HOLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

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

17273 STATE ROUTE 104
CHILLICOTHEE OH
45601-9718
US

IV. Provider business mailing address

17273 STATE ROUTE 104
CHILLICOTHEE OH
45601-9718
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-1141
  • Fax: 740-772-7133
Mailing address:
  • Phone: 740-773-1141
  • Fax: 740-772-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.541054
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: