Most Relevant Information
Provider Data
| NPI Number: | 1003361098 |
| Provider Name: | HOLLY THRAILKILL AGPCNP |
| Entity Type: | Individual |
| Taxonomy Code: | 163WG0000X |
| Specialty: | Registered Nurse |
| License Number: | 759528 |
Most Important Dates
| Enumeration Date: | 08/18/2016 |
| Last Updated: | 07/02/2019 |
Provider Practice Location
1405 S 8TH ST
LA PORTE
TX
775716207
Practice Location Phone/Fax
| Phone: | 8322628358 |
| Fax: |
Provider Mailing Location
1405 S 8TH ST
LA PORTE
TX
775716207
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |