Provider Demographics
NPI:1598916272
Name:HOLIFIELD, KIERSTON DOROTHY (PA)
Entity type:Individual
Prefix:MRS
First Name:KIERSTON
Middle Name:DOROTHY
Last Name:HOLIFIELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 EMERALD PL
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5143
Mailing Address - Country:US
Mailing Address - Phone:706-627-5904
Mailing Address - Fax:
Practice Address - Street 1:4150 WASHINGTON RD STE 6
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4722
Practice Address - Country:US
Practice Address - Phone:706-814-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant