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General NPI Number Information
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NPI Number | 1376979799
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Entity Type | Individual
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Provider Name | HOLLY ROGERS GAINES ANP
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Gender | Female
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 5 MEDICAL LN
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City | CONWAY
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State | AR
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Zip | 72034-4912
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Country | US
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Telephone | 501-224-5200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20430
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City | WHITE HALL
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State | AR
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Zip | 71612-0430
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Country | US
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Telephone | 501-661-9191
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Fax | 501-661-1991
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | A003851
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License Number State | AR
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