Healthcare Provider Details

I. General information

NPI: 1871103754
Provider Name (Legal Business Name): KELLIE D HOLLAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 GLENDALE MILFORD RD
CINCINNATI OH
45241-3134
US

IV. Provider business mailing address

3147 GLENDALE MILFORD RD
CINCINNATI OH
45241-3134
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-1270
  • Fax: 513-346-1281
Mailing address:
  • Phone: 513-346-1270
  • Fax: 513-346-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0030245
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71010642A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: