Provider Demographics
NPI:1952161390
Name:HOLLOWAY, KAYLA ROSE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ROSE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 49TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4494
Mailing Address - Country:US
Mailing Address - Phone:419-351-5474
Mailing Address - Fax:
Practice Address - Street 1:3590 49TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4494
Practice Address - Country:US
Practice Address - Phone:419-351-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula