Provider Demographics
NPI:1639106479
Name:HOLLOWAY, ROY (CRNA)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813A 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-5130
Mailing Address - Country:US
Mailing Address - Phone:870-866-0441
Mailing Address - Fax:
Practice Address - Street 1:1813A 6TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-5130
Practice Address - Country:US
Practice Address - Phone:870-866-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR37140367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U774OtherBLUE CROSS OF AR
AR140681701Medicaid
ARP00278488Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AR140681701Medicaid