Healthcare Provider Details

I. General information

NPI: 1275472417
Provider Name (Legal Business Name): HOLLY AGNER KENNEDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SHADOWMOOR CT
MARTINEZ GA
30907-1310
US

IV. Provider business mailing address

164 SHADOWMOOR CT
MARTINEZ GA
30907-1310
US

V. Phone/Fax

Practice location:
  • Phone: 706-231-0229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP209501
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN209501
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: