Provider Demographics
NPI:1659329860
Name:HOLLOWAY-BALL, CAROLYN J (CNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:J
Last Name:HOLLOWAY-BALL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:J
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1397 WEIMER RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6284
Mailing Address - Country:US
Mailing Address - Phone:505-758-8883
Mailing Address - Fax:
Practice Address - Street 1:1397 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6284
Practice Address - Country:US
Practice Address - Phone:505-758-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR54631163W00000X
NMR54631 CNP01313363LF0000X
NMR54631 CNP 01313363LN0005X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care