Provider Demographics
NPI:1588094726
Name:HATLEY, HOLLY SMITH (FNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:SMITH
Last Name:HATLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:DEANNA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1420 US HWY 52 NORTH, SUITE G
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001
Mailing Address - Country:US
Mailing Address - Phone:704-982-9877
Mailing Address - Fax:704-982-9880
Practice Address - Street 1:1420 US 52 N STE G
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-2622
Practice Address - Country:US
Practice Address - Phone:704-982-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC204971363LF0000X
NC5006616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588094726Medicaid
NC1588094726Medicaid
NCNCG285C904Medicare PIN