Provider Demographics
NPI:1265493522
Name:MUSGROVE, HOLLY C (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:C
Last Name:MUSGROVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 ASHELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4016
Mailing Address - Country:US
Mailing Address - Phone:828-258-8681
Mailing Address - Fax:828-253-4830
Practice Address - Street 1:1219 SMOKEY PARK HWY
Practice Address - Street 2:HOMINY FAMILY HEALTH CENTER
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-9248
Practice Address - Country:US
Practice Address - Phone:828-258-8681
Practice Address - Fax:828-253-4830
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901209Medicaid
NC2010654Medicare PIN
NC8901209Medicaid