Provider Demographics
NPI:1215329370
Name:SPEARS, HOLLEY ALEXANDER (PA-C)
Entity type:Individual
Prefix:
First Name:HOLLEY
Middle Name:ALEXANDER
Last Name:SPEARS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13160 MINDANAO WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6393
Mailing Address - Country:US
Mailing Address - Phone:310-574-0416
Mailing Address - Fax:310-574-0422
Practice Address - Street 1:360 PEAK ONE DR STE 180
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-5948
Practice Address - Country:US
Practice Address - Phone:970-668-3633
Practice Address - Fax:970-668-4406
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2024-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0005108363A00000X
NC0010-05552363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant