Healthcare Provider Details

I. General information

NPI: 1376242586
Provider Name (Legal Business Name): HOLLY C ABSHIRE LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY C MCADAMS LAT

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 NE LOOP 286
PARIS TX
75460-2219
US

IV. Provider business mailing address

1675 NE LOOP 286
PARIS TX
75460-2219
US

V. Phone/Fax

Practice location:
  • Phone: 903-782-9922
  • Fax:
Mailing address:
  • Phone: 903-782-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT5204
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: