Provider Demographics
NPI:1558982843
Name:HOLDERFIELD, KIMBERLY CONSTANCE (APRN CNM)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CONSTANCE
Last Name:HOLDERFIELD
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 HOPEWELL KC
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029
Mailing Address - Country:US
Mailing Address - Phone:321-750-3433
Mailing Address - Fax:
Practice Address - Street 1:3886 PRINCETON LAKES WAY SW STE 280
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5511
Practice Address - Country:US
Practice Address - Phone:404-346-7100
Practice Address - Fax:404-346-1122
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN243651163W00000X, 363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner