Provider Demographics
NPI:1790311314
Name:HOLYFIELD, ANGELA MICHAELA (PMHNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHAELA
Last Name:HOLYFIELD
Suffix:
Gender:F
Credentials:PMHNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 DEBSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2826
Mailing Address - Country:US
Mailing Address - Phone:501-304-0807
Mailing Address - Fax:
Practice Address - Street 1:135 SAWTOOTH OAK ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7160
Practice Address - Country:US
Practice Address - Phone:501-781-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-15
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122455363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health