Shanna Couch Holliday, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7633 Issued in KY

Practice address

251 Morton Blvd
Hazard, KY 41701-9470

Phone

(606) 439-1079

Fax

(606) 439-3878

NPI assigned

Feb 21, 2007

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 identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

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

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.

• Shanna Couch Holliday

  • Dentist
  • Hazard, KY
  • NPI 1881965879
  NPD (past)

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342051200000",
    "number": "1508901166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 DOCTORS ROW",
            "city": "CHAVIES",
            "state": "KY",
            "postal_code": "417278954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 MORTON BLVD",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417019470",
            "telephone_number": "606-439-1079",
            "fax_number": "606-439-3878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUCH HOLLIDAY",
        "first_name": "SHANNA",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-21",
        "last_updated": "2012-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "7633",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "7633",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60000262",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45003811",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Cornett
• Teresa Cornett
• Tracy Cornett
• Whitney Leeann Cornett
• Ashley Leeann Costello
• Gina Jo Couch
• Linda Couch
• Peter Couch
• Ryan Joseph Couch, APRN
• Villa Couch

• All providers in Hazard, KY
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2012; 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.