=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821280181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLY NICOLE ZELLER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2007
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 395 INTERSTATE DR
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37355-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 872-231-3162
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 74008272
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60674-8272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-899-0595
-----------------------------------------------------
Fax | 702-977-1496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 50.002645
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------