Provider Demographics
NPI:1023546256
Name:HOLLOWAY, SAMUEL KYLE (PA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KYLE
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 CENTERVILLE TPKE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6839
Mailing Address - Country:US
Mailing Address - Phone:757-362-9067
Mailing Address - Fax:
Practice Address - Street 1:1944 CENTERVILLE TPKE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6839
Practice Address - Country:US
Practice Address - Phone:757-362-9067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005806363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant