Provider Demographics
NPI:1114226792
Name:GROOMS, HOLLY LYNN (MSN, APRN, ACNP-BC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:GROOMS
Suffix:
Gender:F
Credentials:MSN, APRN, ACNP-BC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:HOLFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, ACNP-BC
Mailing Address - Street 1:PO BOX 896258
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6258
Mailing Address - Country:US
Mailing Address - Phone:803-744-4900
Mailing Address - Fax:803-744-4938
Practice Address - Street 1:2728 SUNSET BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6502
Practice Address - Country:US
Practice Address - Phone:803-744-4900
Practice Address - Fax:803-744-4938
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4474363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1938Medicaid
1114226792OtherNPI
SC7399Medicare PIN