Basic Information
| Provider Information | |||||||||
| NPI: | 1699154674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAWSON | ||||||||
| OtherFirstName: | HOLLY | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 209 N MAYSVILLE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | MOUNT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403531179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594047686 | ||||||||
| FaxNumber: | 8594988160 | ||||||||
| Practice Location | |||||||||
| Address1: | 2330 CONCRETE RD | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403119700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594054025 | ||||||||
| FaxNumber: | 8595173014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3009400 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 7100354590 | 05 | KY | MEDICAID | K141040 | 01 | MEDICARE NUMBER (CYNTHIANA) | OTHER | 3009400 | 01 | KY | APRN LICENSE | OTHER | K141041 | 01 | MEDICARE NUMBER (CARLISLE) | OTHER |