Provider Demographics
NPI:1023226586
Name:DUDLEY-HARRELL, HOLLY N (MD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:N
Last Name:DUDLEY-HARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6621 FANNIN ST
Mailing Address - Street 2:CC1250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2303
Mailing Address - Country:US
Mailing Address - Phone:832-822-1268
Mailing Address - Fax:832-825-1717
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:CC1250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-822-1268
Practice Address - Fax:832-825-1717
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM65902084N0402X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K0996Medicare PIN