Provider Demographics
NPI:1528305646
Name:LOLLAR, KATHRYN (MSN, ANP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LOLLAR
Suffix:
Gender:F
Credentials:MSN, ANP
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:BUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:6500 HOSPITAL DRIVE SUITE 2B
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1239
Mailing Address - Country:US
Mailing Address - Phone:573-629-3500
Mailing Address - Fax:573-629-3514
Practice Address - Street 1:6500 HOSPITAL DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6890
Practice Address - Country:US
Practice Address - Phone:573-629-3500
Practice Address - Fax:573-629-3514
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007021077163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse