Provider Demographics
NPI:1902907470
Name:HOLLOWAY, KATHLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NAT WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1982
Mailing Address - Country:US
Mailing Address - Phone:509-754-3330
Mailing Address - Fax:509-754-2351
Practice Address - Street 1:220 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823
Practice Address - Country:US
Practice Address - Phone:509-754-3330
Practice Address - Fax:509-754-2351
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004276363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0301659OtherL&I
WAP01110206OtherRR MEDICARE
WA1902907470Medicaid
WA0301659OtherL&I
WAP01110206OtherRR MEDICARE