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General NPI Number Information
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NPI Number | 1295036275
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Entity Type | Individual
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Provider Name | HOLLIE A KELLY
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Gender | Female
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 905 E MAIN ST
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City | OLNEY
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State | IL
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Zip | 62450-2623
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Country | US
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Telephone | 618-393-7732
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Fax | 618-395-3123
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Provider Business Mailing Address
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Address Line | 905 E MAIN ST
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City | OLNEY
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State | IL
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Zip | 62450-2623
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Country | US
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Telephone | 618-393-7732
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Fax | 618-395-3123
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 041233726
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License Number State | IL
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