Provider Demographics
NPI:1699154674
Name:BECKER, HOLLY (APRN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 N MAYSVILLE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1179
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-498-8160
Practice Address - Street 1:2330 CONCRETE RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-9700
Practice Address - Country:US
Practice Address - Phone:859-405-4025
Practice Address - Fax:859-517-3014
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100354590Medicaid
K141040OtherMEDICARE NUMBER (CYNTHIANA)
KY3009400OtherAPRN LICENSE
K141041OtherMEDICARE NUMBER (CARLISLE)