MEDICARE: MR. CHAD LEE HOLLYFIELD FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	HOLL-W61UZ	NC

General Provider Information

NPI Number	:	1255047569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHAD LEE HOLLYFIELD FNP-C

Provider Business Mailing Address
First Line	:	4904 LEE DR
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-9668
Country	:	US
Telephone Number	:	919-756-9918
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 OLD ROBERTS RD
Second Line	:
City	:	BENSON
State	:	NC
Zip	:	27504-8047
Country	:	US
Telephone Number	:	919-934-2600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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