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NPI Code Detail

MEDICARE: MR. BARRY PAUL HOLLOWAY PA-C

MEDICARE: MR. BARRY PAUL HOLLOWAY PA-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
1363A00000XPhysician AssistantPA-602AR

General Provider Information

NPI Number : 1871986315
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BARRY PAUL HOLLOWAY PA-C
Provider Business Mailing Address
First Line : 2707 MARKET TRACE
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-8694
Country : US
Telephone Number : 479-434-3600
Fax Number : 833-992-0797
Provider Business Practice Location Address
First Line : 2707 MARKET TRACE
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-8694
Country : US
Telephone Number : 479-434-3600
Fax Number : 833-992-0797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2015
Last Update Date : 03/20/2025

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