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General NPI Number Information
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NPI Number | 1225576119
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Entity Type | Individual
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Provider Name | KATHERINE CANOY HOLLOWAY PA
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Gender | Female
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 10628 PARK RD
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City | CHARLOTTE
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State | NC
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Zip | 28210-8407
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Country | US
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Telephone | 704-667-1147
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E W T HARRIS BLVD SUITE 3109
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City | CHARLOTTE
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State | NC
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Zip | 28262-3485
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Country | US
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Telephone | 330-445-4361
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Fax | 330-451-4197
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001007075
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License Number State | NC
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