Healthcare Provider Details

I. General information

NPI: 1588296545
Provider Name (Legal Business Name): GARNET K.B. HOLLIDAY RN, BSN, LCCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GARNET K BYER

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 FARMER DR
MEDWAY OH
45341-9510
US

IV. Provider business mailing address

315 FARMER DR
MEDWAY OH
45341-9510
US

V. Phone/Fax

Practice location:
  • Phone: 937-902-1289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.177358
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.177358
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: