Provider Demographics
NPI:1568155745
Name:HOLLOWAY, CODIE
Entity Type:Individual
Prefix:
First Name:CODIE
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 PECAN
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-5928
Mailing Address - Country:US
Mailing Address - Phone:918-604-6054
Mailing Address - Fax:918-777-9018
Practice Address - Street 1:1228 PECAN
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-5928
Practice Address - Country:US
Practice Address - Phone:918-604-6054
Practice Address - Fax:918-777-9018
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator