Healthcare Provider Details

I. General information

NPI: 1720327174
Provider Name (Legal Business Name): HOLLY A HOLSTON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7023 OLD JAHNKE RD
RICHMOND VA
23225-4126
US

IV. Provider business mailing address

1867 HOPE MEADOW WAY
POWHATAN VA
23139-7061
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-1353
  • Fax:
Mailing address:
  • Phone: 804-320-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024169649
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: