Provider Demographics
NPI:1770019531
Name:HOLBROOK, KATHERINE B (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:B
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1624 MAIN STREET
Mailing Address - Street 2:AGAPE SENIOR PRIMARY CARE, INC.
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2818
Mailing Address - Country:US
Mailing Address - Phone:803-726-2283
Mailing Address - Fax:803-753-9102
Practice Address - Street 1:2600 ELMS PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9164
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:843-782-4044
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22452363LF0000X
SC20938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily