Provider Demographics
NPI:1104454842
Name:HOLDSWORTH, KAREN LEIGH (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LEIGH
Last Name:HOLDSWORTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2604 RIVER BASIN LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6379
Mailing Address - Country:US
Mailing Address - Phone:301-934-2365
Mailing Address - Fax:
Practice Address - Street 1:214 E ELM ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3022
Practice Address - Country:US
Practice Address - Phone:336-226-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179078363L00000X
NC5015117363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024179078OtherSTATE LICENSE