| Doctor Name: | CONSTANCE HOLLIS |
| NPI Number: | 1174805584 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | R68850 |
| Business Practice Address: | 634 W Main St Blytheville, AR - 723153336 |
| Business Phone Number: | 8707806986 |
| Business Fax Number: | 8707806987 |
| Mailing Address: | 634 W Main St, BLYTHEVILLE |
| State: | AR |
| Postal Code: | 723153336 |
| Phone Number: | 8707806986 |
| Fax Number: | 8707806987 |
| NPI Enumeration Date: | 09/12/2011 |
| NPI Last Update Date: | 09/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0807X |
| License Number: | R68850 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Child & Adolescent |
| Taxonomy Definition: | |