1538683024 NPI number — MR. JAMES HOLLON FNP-C

Table of content: MR. JAMES HOLLON FNP-C (NPI 1538683024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538683024 NPI number — MR. JAMES HOLLON FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLON
Provider First Name:
JAMES
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538683024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GORDON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76453-0306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-693-5211
Provider Business Mailing Address Fax Number:
254-693-5774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GORDON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76453-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-693-5211
Provider Business Practice Location Address Fax Number:
254-693-5774
Provider Enumeration Date:
07/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP134589 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1588778260 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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