Provider Demographics
NPI:1023642329
Name:HOLADAY, HEATHER BROOKE (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:BROOKE
Last Name:HOLADAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 180TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67529-2933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:713 W 11TH ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-2055
Practice Address - Country:US
Practice Address - Phone:620-804-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS128062163W00000X
KS53-79521-052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse