Provider Demographics
NPI:1770679839
Name:HOLMAN, KATHERINE (FNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHERIN
Other - Middle Name:
Other - Last Name:HOLMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:5838 EDISON PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-5520
Mailing Address - Country:US
Mailing Address - Phone:760-300-3664
Mailing Address - Fax:760-444-2211
Practice Address - Street 1:4929 WILSHIRE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3820
Practice Address - Country:US
Practice Address - Phone:562-904-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00035900363L00000X
CA95001319364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner