=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588094726
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLY SMITH HATLEY FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2013
-----------------------------------------------------
Last Update Date | 07/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 US 52 N STE G
-----------------------------------------------------
City | ALBEMARLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28001-2622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-982-9877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1420 US HWY 52 NORTH, SUITE G
-----------------------------------------------------
City | ALBEMARLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-982-9877
-----------------------------------------------------
Fax | 704-982-9880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 204971
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5006616
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------