Holli Dezaun Waller, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0116022785 Issued in VA

Practice address

3700 South Main Street
Blacksburg, VA 24060

Phone

(540) 953-5445

Fax

(540) 953-5453

NPI assigned

Jun 24, 2010

Last updated

Jun 24, 2010By the provider in NPPES

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

Other names 1

• Holli Dezaun Holman Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Premier Provider Health PA

  • Infectious Disease Physician
  • Austin, TX
  • NPI 1013397066
  Medicare reassignment NPD
• Regional Employee Assistance Program Inc

  • Family Medicine Physician
  • Corsicana, TX
  • NPI 1649232984
  Medicare reassignment NPD
• Premier Provider Health PA

  dba Han Pham Hulen, MD PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1700032745
  NPD
• Regional Employee Assistance Program Inc

  • Cardiovascular Disease Physician
  • Abilene, TX
  • NPI 1073575585

  Family Medicine

  NPD
• Regional Employee Assistance Program Inc

  • Family Medicine Physician
  • College Station, TX
  • NPI 1881656247
  NPD
• Premier Provider Health PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1235280496
  NPD (past)
• Premier Provider Health Utah PLLC

  dba Wound Integrity Utah

  • Internal Medicine Physician
  • Ogden, UT
  • NPI 1699311209

  Family Medicine

  NPD (past)
• Regional Employee Assistance Program Inc

  • Internal Medicine Physician
  • College Station, TX
  • NPI 1053373951

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277337600000",
    "number": "1053622167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6326 STONEWOOD POINTE LN.",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77066",
            "telephone_number": "281-300-9849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 SOUTH MAIN STREET",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "24060",
            "telephone_number": "540-953-5445",
            "fax_number": "540-953-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "HOLLI",
        "middle_name": "DEZAUN",
        "name_prefix": "Mrs.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-24",
        "last_updated": "2010-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0116022785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLLI",
            "last_name": "HOLMAN",
            "middle_name": "DEZAUN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Walgreen Co (Rite Aid #1181)
• Walgreen Co (Moog InHealth Pharmacy #21324)
• Jennifer Walker, MS, LAT, ATC
• Patricia Ruth Walker, RN, MS, CS
• Wallace L Huff DDS
• Julie Nicole Walsh
• Nicole Walters, DNP, PMHNP, RN
• Nora Wang, MD
• Yanping Wang, PH.D.
• Justin Waninger, CRNA

• Family Medicine Physician in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.