Healthcare Provider Details

I. General information

NPI: 1043728660
Provider Name (Legal Business Name): HOLLY ANN BARDEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 E ROOSEVELT BLVD
MONROE NC
28112-4017
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-226-0500
  • Fax: 704-226-0599
Mailing address:
  • Phone: 704-226-0500
  • Fax: 704-226-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010151
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010151
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: