Provider Demographics
NPI:1144069949
Name:HAZARD, HOLLY D (APRN-CNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:D
Last Name:HAZARD
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:D
Other - Last Name:HARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:WETUMKA
Mailing Address - State:OK
Mailing Address - Zip Code:74883-0236
Mailing Address - Country:US
Mailing Address - Phone:405-257-5422
Mailing Address - Fax:405-257-5463
Practice Address - Street 1:207 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-2103
Practice Address - Country:US
Practice Address - Phone:405-257-5422
Practice Address - Fax:405-257-5463
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK220118363LF0000X
TX1158948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily