Provider Demographics
NPI:1639174998
Name:HOLLAND, KATHLEEN M (M D)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 SIDNEY BAKER
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-2725
Mailing Address - Country:US
Mailing Address - Phone:830-896-2812
Mailing Address - Fax:830-896-5255
Practice Address - Street 1:1436 SIDNEY BAKER
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2725
Practice Address - Country:US
Practice Address - Phone:830-896-2812
Practice Address - Fax:830-896-5255
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2008-10-28
Deactivation Date:2006-03-28
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
TXF8161208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126430102Medicaid
TX1264301-04Medicaid
TX1264301-04Medicaid
TX126430102Medicaid