Provider Demographics
NPI:1750994240
Name:HOLLIDAY, STEPHANIE D (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 KATES MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2381
Mailing Address - Country:US
Mailing Address - Phone:304-536-8018
Mailing Address - Fax:
Practice Address - Street 1:167 KATES MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986-2381
Practice Address - Country:US
Practice Address - Phone:304-536-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily