=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255047569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAD LEE HOLLYFIELD FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2023
-----------------------------------------------------
Last Update Date | 01/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58 OLD ROBERTS RD
-----------------------------------------------------
City | BENSON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27504-8047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-934-2600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4904 LEE DR
-----------------------------------------------------
City | GARNER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27529-9668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-756-9918
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | HOLL-W61UZ
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------