Provider Demographics
NPI:1538527817
Name:HOLDERFIELD, KELLY (FNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:HOLDERFIELD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 CARROLLTON PIKE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3034
Mailing Address - Country:US
Mailing Address - Phone:276-238-0911
Mailing Address - Fax:276-238-0912
Practice Address - Street 1:5261 CARROLLTON PIKE
Practice Address - Street 2:SUITE C
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3034
Practice Address - Country:US
Practice Address - Phone:276-238-0911
Practice Address - Fax:276-238-0912
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0017142656OtherAUTHORIZATION TO PRESCRIBE
VA0024173248OtherFNP LICENSE