Holly Anne Haines, PA-C, RDN

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1220046

Practice address

4881 Sugar Maple Dr
Wright Patterson Afb, OH 45433-5529

Phone

(937) 522-2778

NPI assigned

Apr 15, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Holly Anne Piatt Former name

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1477972768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "379-257-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-522-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAINES",
        "first_name": "HOLLY",
        "middle_name": "ANNE",
        "credential": "PA-C, RDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-15",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "1079535",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "1220046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "PIATT",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alan Douglas Guhlke, M.D.
• Deanna Kathryn Guzman
• Grace Ann Gwin, DDS
• Gregory James Haack, MD
• James Cameron Haak, M.D.
• Kole Hale, DO
• Lucy Hale, DO
• Tia Hale, LISW-S
• Stephen F Hamilton, PHD
• Jaron Jay Hansen, MD

• Physician Assistant in Wright Patterson Afb, OH
• Providers in Wright Patterson Afb, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.