Basic Information
| Provider Information | |||||||||
| NPI: | 1639536972 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHITWOOD | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | RENEA | ||||||||
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| Credential: | NURSE PRATITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | UK HEMATOLOGY CLINIC | ||||||||
| Address2: | 800 ROSE ST, #140 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592576006 | ||||||||
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| Practice Location | |||||||||
| Address1: | UK HEMATOLOGY CLINIC | ||||||||
| Address2: | 800 ROSE ST, #140 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592576006 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2016 | ||||||||
| LastUpdateDate: | 06/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3010014 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 3010014 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.