Healthcare Provider Details

I. General information

NPI: 1538702337
Provider Name (Legal Business Name): KATHY L HOLDEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126A E HIGH ST
ELKTON MD
21921-5638
US

IV. Provider business mailing address

322 E CECIL AVE
NORTH EAST MD
21901-4012
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-8300
  • Fax: 410-398-8469
Mailing address:
  • Phone: 410-287-3727
  • Fax: 410-287-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR165091
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: