Provider Demographics
NPI:1700442886
Name:HOLLOWAY, MICA KRISTIN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICA
Middle Name:KRISTIN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3064
Mailing Address - Country:US
Mailing Address - Phone:580-254-8669
Mailing Address - Fax:580-254-8026
Practice Address - Street 1:1611 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801
Practice Address - Country:US
Practice Address - Phone:580-254-8669
Practice Address - Fax:580-254-8026
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner