Healthcare Provider Details

I. General information

NPI: 1427982917
Provider Name (Legal Business Name): NATHANIEL HOLLOWAY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19534 MIDLAND TRL APT 24D
ANSTED WV
25812-8629
US

IV. Provider business mailing address

PO BOX 725
ANSTED WV
25812-0725
US

V. Phone/Fax

Practice location:
  • Phone: 540-960-1988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: