Provider Demographics
NPI:1447786207
Name:HOLYFIELD, KATHERINE RAE (MSN AGPCNP-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RAE
Last Name:HOLYFIELD
Suffix:
Gender:F
Credentials:MSN AGPCNP-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:YAKOWICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5758 COOLEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-3073
Mailing Address - Country:US
Mailing Address - Phone:855-466-3631
Mailing Address - Fax:810-244-0226
Practice Address - Street 1:5758 COOLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-3073
Practice Address - Country:US
Practice Address - Phone:855-466-3631
Practice Address - Fax:810-244-0226
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704282989363LA2200X, 363LP2300X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine