Healthcare Provider Details

I. General information

NPI: 1659329860
Provider Name (Legal Business Name): CAROLYN J HOLLOWAY-BALL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN J HOLLOWAY CNP

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 WEIMER RD
TAOS NM
87571-6284
US

IV. Provider business mailing address

1397 WEIMER RD
TAOS NM
87571-6284
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-8883
  • Fax:
Mailing address:
  • Phone: 505-758-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR54631
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR54631 CNP01313
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberR54631 CNP 01313
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR54631 CNP 01313
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: