Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 53693 | KY |
Y | 208600000X | Surgeon | 53693 | KY |
NPI | 1992184030 |
---|---|
Provider Name | Tyler B. Holley |
First Address | London, KY 40743-0936 |
Second Address | Bardstown, KY 40004-8040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 15/06/2020 |