Provider Demographics
NPI:1558921098
Name:BETTERLY, HOLLY (MD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:BETTERLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1825 MAIN ST STE 16
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3683
Mailing Address - Country:US
Mailing Address - Phone:954-953-5675
Mailing Address - Fax:954-932-3790
Practice Address - Street 1:1825 MAIN ST STE 16
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3683
Practice Address - Country:US
Practice Address - Phone:954-953-5675
Practice Address - Fax:954-932-3790
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT2182242084P0800X
FLME1610182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry