Provider Demographics
NPI:1184056475
Name:HOLLOWAY, JENNIFER (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HOLLOWAY
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 1:11209 RANNOCH LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1253
Mailing Address - Country:US
Mailing Address - Phone:502-262-0266
Mailing Address - Fax:
Practice Address - Street 1:690 KNOX ST
Practice Address - Street 2:STE. 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1337
Practice Address - Country:US
Practice Address - Phone:502-262-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1120533163W00000X
KY3008227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse