KELLIE MARIE HOLLOWAY (NPI# 1679096424) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679096424 |
| Entity Type | Individual |
| Full Name | KELLIE MARIE HOLLOWAY |
| Credential | PA-C |
| Practice Address |
1325 San Marco Blvd Ste 200 Jacksonville FL 32207-8566 |
| Practice Telephone | 9043463465 |
| Practice Fax Number | 9043960388 |
| Mailing Telephone | 9043463465 |
| Mailing Fax Number | 9048586489 |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2017-11-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9110764 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992077499 | Kellie Marie Holloway | Physical Therapist | 3236 Se Alder St Apt 1, Portland, OR 97214-3174 | 2012-01-31 |
| Street Address |
1325 SAN MARCO BLVD STE 200 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32207-8566 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447252655 | Steven Mccarthy Crenshaw | Orthopaedic Surgery | 1325 San Marco Blvd Ste 200, Credentialing Department, Jacksonville, FL 32207-8566 | 2005-06-01 |
| 1992355887 | Zachary Cole White | Physician Assistant | 1325 San Marco Blvd Ste 200, Jacksonville, FL 32207-8566 | 2019-09-12 |
| 1649825639 | Tristyn Kinser | Specialist/Technologist | 1325 San Marco Blvd Ste 200, Jacksonville, FL 32207-8566 | 2019-08-06 |
| 1194379578 | Cesar Enrique Roman-negron | Specialist/Technologist | 1325 San Marco Blvd Ste 200, Jacksonville, FL 32207-8566 | 2019-07-24 |
| 1023578895 | James Martin Duross Iv | Nurse Practitioner | 1325 San Marco Blvd Ste 200, Jacksonville, FL 32207-8566 | 2019-03-20 |
| 1457819146 | Justin T Juelich | Physician Assistant | 1325 San Marco Blvd Ste 200, Jacksonville, FL 32207-8566 | 2019-03-12 |
| 1629535307 | Courtney C Calcote | Physician Assistant | 1325 San Marco Blvd Ste 200, Jacksonville, FL 32207-8566 | 2019-02-28 |
| 1003389925 | Savannah Faulk | Physical Therapist | 1325 San Marco Blvd Ste 200, Jacksonville, FL 32207-8566 | 2019-01-03 |
| 1497223093 | Victoria C. Pursley | Nurse Practitioner | 1325 San Marco Blvd Ste 200, Jacksonville, FL 32207-8566 | 2018-11-13 |
| 1376087064 | Megan Gilman | Nurse Practitioner | 1325 San Marco Blvd Ste 200, Jacksonville, FL 32207-8566 | 2016-12-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033768981 | North Florida Pediatrics, Pa | Pediatrics | 4501 Atlantic Boulevard, Jacksonville, FL 32207 | 2019-09-04 |
| 1578117024 | Pragna Mukesh Dholakia | Nurse Practitioner | 2624 Atlantic Blvd., Jacksonville, FL 32207 | 2019-08-01 |
| 1821653601 | The Adoption Authority, Inc. | Case Management | 4940 Emerson Street, Suite 103, Jacksonville, FL 32207 | 2019-05-07 |
| 1255896080 | Elizabeth Lynn Houghton | Social Worker | Sulzbacher Village, 904-720-2079, Jacksonville, FL 32207 | 2019-02-06 |
| 1902374630 | Guilherme Jose Agnoletto | Neurological Surgery | 800 Prudential Drive Weaver Tower 11th Floor, Jacksonville, FL 32207 | 2018-11-12 |
| 1073008504 | Pavilion Infusion Therapy Inc | Durable Medical Equipment & Medical Supplies | 1301 Palm Avenue, Suite 220, Jacksonville, FL 32207 | 2018-06-27 |
| 1346733185 | Dueseason1 | Registered Nurse | 4058 Saint Augustine Rd, Jacksonville, FL 32207 | 2018-06-06 |
| 1164911913 | Eric Lang Poovey | Nurse Practitioner | Baptist Heart Specialists, 836 Prudential Drive Suite 1700, Jacksonville, FL 32207 | 2018-05-08 |
| 1902311046 | Spring Park Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3851 Emerson St Ste 13, Jacksonville, FL 32207 | 2017-12-12 |
| 1295247948 | Emed Urgent and Primary Care Pa | Clinic/Center | 2570 Atlantic Boulevard, Jacksonville, FL 32207 | 2017-11-02 |
| Find all providers in zip 32207 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831799527 | Emily Vander Zee | Physician Assistant | 6680 Bennett Creek Dr Apt 213, Jacksonville, FL 32216-0018 | 2020-10-30 |
| 1245830314 | Jonathan V Korah | Physician Assistant | 6650 Corporate Center Pkwy Apt 1108, Jacksonville, FL 32216-8725 | 2020-10-28 |
| 1255931473 | Rachel Gavrielle Stahly | Physician Assistant | 11438 Emuness Rd, Jacksonville, FL 32218-4050 | 2020-10-27 |
| 1760099071 | Laura Alexandra Ramos-heckman | Physician Assistant | 2014 Capistrano Dr, Jacksonville, FL 32224-3091 | 2020-09-30 |
| 1184230583 | Julian Clouse | Physician Assistant | 9803 Creekfront Rd Apt 307, Jacksonville, FL 32256-8449 | 2020-09-21 |
| 1962016717 | Stephanie Benton Gentry | Physician Assistant | 3179 Shadow Creek Rd, Jacksonville, FL 32226-2386 | 2020-08-31 |
| 1629689435 | Monarch Mental Health Association | Physician Assistant | 5393 Roosevelt Blvd Ste 8, Jacksonville, FL 32210-8424 | 2020-08-14 |
| 1235749425 | Nicole Lhommedieu | Physician Assistant | 3850 Marnie Pl, Jacksonville, FL 32223-3541 | 2020-08-03 |
| 1861002123 | Naw-am Acio Daniels | Physician Assistant | 7467 Volley Dr N, Jacksonville, FL 32277-9368 | 2020-08-03 |
| 1750906640 | Veronica Adriana Dediego | Physician Assistant | 915 W Monroe St Ste 300, Jacksonville, FL 32204-1177 | 2020-06-16 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32207 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.