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NPI Code Detail

MEDICARE: KATHERINE RAE HOLYFIELD MSN AGPCNP-C

MEDICARE: KATHERINE RAE HOLYFIELD MSN AGPCNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner4704282989MI
2363LP2300XPrimary Care Nurse Practitioner4704282989MI
3163WC0200XCritical Care Medicine Registered Nurse4704282989MI

General Provider Information

NPI Number : 1447786207
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE RAE HOLYFIELD MSN AGPCNP-C
Provider Business Mailing Address
First Line : 5758 COOLEY LAKE RD
Second Line :
City : WATERFORD
State : MI
Zip : 48327-3073
Country : US
Telephone Number : 855-466-3631
Fax Number : 810-244-0226
Provider Business Practice Location Address
First Line : 5758 COOLEY LAKE RD
Second Line :
City : WATERFORD
State : MI
Zip : 48327-3073
Country : US
Telephone Number : 855-466-3631
Fax Number : 810-244-0226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 05/31/2024

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