Provider Demographics
NPI:1053573246
Name:HALL, HOLLY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:799 E BRANNON RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-6038
Mailing Address - Country:US
Mailing Address - Phone:859-971-4670
Mailing Address - Fax:859-971-4604
Practice Address - Street 1:1740 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1431
Practice Address - Country:US
Practice Address - Phone:859-260-6100
Practice Address - Fax:859-260-4350
Is Sole Proprietor?:No
Enumeration Date:2008-06-28
Last Update Date:2020-12-03
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Provider Licenses
StateLicense IDTaxonomies
KY42099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100092440Medicaid
KYK018171Medicare PIN