Provider Demographics
NPI:1154615045
Name:HOLLISTER, STEPHEN KEITH (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KEITH
Last Name:HOLLISTER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:152-392-0186
Mailing Address - Fax:
Practice Address - Street 1:345 23RD AVE N STE 300
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1513
Practice Address - Country:US
Practice Address - Phone:615-342-5740
Practice Address - Fax:615-342-5742
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11015974208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11015974OtherINDIANA PROFESSIONAL LICENSING AGENCY
TN55293OtherTN BOARD OF MEDICAL EXAMINERS