Provider Demographics
NPI:1992943674
Name:SIMS, HOLLY SIMS (CRNA)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:SIMS
Last Name:SIMS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:55 FOUNDATION DR
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-9815
Mailing Address - Country:US
Mailing Address - Phone:606-849-5000
Mailing Address - Fax:
Practice Address - Street 1:55 FOUNDATION DR
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-9815
Practice Address - Country:US
Practice Address - Phone:606-849-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5911A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100091860Medicaid
KY7100091860Medicaid