Provider Demographics
NPI:1932211729
Name:HOLLOWAY, MATTHEW E (CRNA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 JETTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339
Mailing Address - Country:US
Mailing Address - Phone:606-666-6000
Mailing Address - Fax:606-666-6102
Practice Address - Street 1:540 JETTS DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339
Practice Address - Country:US
Practice Address - Phone:606-666-6000
Practice Address - Fax:606-666-6102
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1109901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100021760Medicaid
KY000000492112OtherBCBS
KY7100021760Medicaid
KY0608474Medicare PIN