Healthcare Provider Details

I. General information

NPI: 1033519558
Provider Name (Legal Business Name): KARA HOLDREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10003 WEBSTER RD
CAMDEN ON GAULEY WV
26208-7713
US

IV. Provider business mailing address

PO BOX 69
CAMDEN ON GAULEY WV
26208-0069
US

V. Phone/Fax

Practice location:
  • Phone: 304-226-5725
  • Fax:
Mailing address:
  • Phone: 304-226-5725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN69383NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: