Healthcare Provider Details

I. General information

NPI: 1902780018
Provider Name (Legal Business Name): CALLIE HOLLOWAY MSN, APRN, FNP-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33413 RUSTY CT
WINCHESTER CA
92596-1736
US

IV. Provider business mailing address

10509 STAR QUEST AVE
LAS VEGAS NV
89144-1103
US

V. Phone/Fax

Practice location:
  • Phone: 951-764-0385
  • Fax:
Mailing address:
  • Phone: 951-764-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number841825
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number841825
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: