Kristy Holly, LPN

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

753805 Issued in WA

Practice address

205 Pelican Dr
Kelso, WA 98626-5811

Phone

(360) 353-5717

Fax

(360) 998-3420

NPI assigned

Jul 31, 2026

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1785456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785456000000",
    "number": "1023931672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 PELICAN DR",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986265811",
            "telephone_number": "360-353-5717",
            "fax_number": "360-998-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 PELICAN DR",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986265811",
            "telephone_number": "360-353-5717",
            "fax_number": "360-998-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLY",
        "first_name": "KRISTY",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-07-31",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "WA",
            "license": "753805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Kelso, WA
• Providers in Kelso, WA by specialty
• Adult Care Home Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.