Provider Demographics
NPI:1679086656
Name:BORKERT, HOLLY (CNM)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BORKERT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:213 S JEFFERSON ST STE 625
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5374
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:2875 BARN RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6389
Practice Address - Country:US
Practice Address - Phone:540-731-4578
Practice Address - Fax:540-731-3061
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2021-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024175366363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology