Active NPI
Kevin B Holloway, MD
- Psychiatry Physician
- Wellington, KS
National Provider Identifier
1003813387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 04-21041
- Practice address
- 1601 W 16TH St
Wellington, KS 67152-8125 - Phone
- (620) 326-7448
- Fax
- (620) 326-6662
- NPI assigned
- Jul 1, 2005
- Last updated
- Mar 28, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 04-21041 | KS | Primary |
Addresses
Primary practice location
1601 W 16TH St
Wellington, KS 67152-8125
Mailing address
1601 W 16TH St
Wellington, KS 67152-8125
Phone (620) 326-7448
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2050631302 | Medicaid | KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-21041 | KS | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332892800000",
"number": "1003813387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 W 16TH ST",
"city": "WELLINGTON",
"state": "KS",
"postal_code": "671528125",
"telephone_number": "620-326-7448",
"fax_number": "620-326-6662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 W 16TH ST",
"city": "WELLINGTON",
"state": "KS",
"postal_code": "671528125",
"telephone_number": "620-326-7448",
"fax_number": "620-326-6662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLOWAY",
"first_name": "KEVIN",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-01",
"last_updated": "2012-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "KS",
"license": "04-21041",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2050631302",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wellington, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.