Provider Demographics
NPI:1679450225
Name:BRADDY, HOLLY WHITEHURST (LPN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:WHITEHURST
Last Name:BRADDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N REED DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3247
Mailing Address - Country:US
Mailing Address - Phone:252-495-3865
Mailing Address - Fax:
Practice Address - Street 1:2070 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3769
Practice Address - Country:US
Practice Address - Phone:252-565-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75704164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse