Provider Demographics
NPI:1700423019
Name:DISIBBIO, HOLLY (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:DISIBBIO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:DISIBBIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 WESTWOOD CMN
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-2031
Mailing Address - Country:US
Mailing Address - Phone:276-235-6232
Mailing Address - Fax:276-250-5117
Practice Address - Street 1:105 WESTWOOD CMN
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2031
Practice Address - Country:US
Practice Address - Phone:276-235-6232
Practice Address - Fax:276-250-5117
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104840363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health