Provider Demographics
NPI:1861927147
Name:HOLLEY, SARAH (RD LD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1509
Mailing Address - Country:US
Mailing Address - Phone:315-408-9213
Mailing Address - Fax:
Practice Address - Street 1:906 CLIFFSIDE DR
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1509
Practice Address - Country:US
Practice Address - Phone:315-408-9213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84089133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered