Healthcare Provider Details

I. General information

NPI: 1770891137
Provider Name (Legal Business Name): HOLLY BRYAN GRADY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY ELISABETH BRYAN

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6527 STATE PARK RD
TRAVELERS REST SC
29690-1696
US

IV. Provider business mailing address

6527 STATE PARK RD
TRAVELERS REST SC
29690-1696
US

V. Phone/Fax

Practice location:
  • Phone: 864-610-2108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number19474
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: