Provider Demographics
NPI:1548574445
Name:KILBY, HOLLY A (CRNP-ADULT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:KILBY
Suffix:
Gender:F
Credentials:CRNP-ADULT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 PROGRESS WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6464
Mailing Address - Country:US
Mailing Address - Phone:410-795-0257
Mailing Address - Fax:410-549-7354
Practice Address - Street 1:1380 PROGRESS WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6464
Practice Address - Country:US
Practice Address - Phone:410-794-0257
Practice Address - Fax:410-549-7354
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169747363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health