Mariah Holloway, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209024007 Issued in IL

Practice address

2426 W Cornerstone CT Ste 100
Peoria, IL 61614-2400

Phone

(309) 966-3137

NPI assigned

Jan 4, 2022

Sex

Female

Sole proprietor

No

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

Credentials

Nurse Practitioner

State licenses

Practice roles

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

• Central Illinois Preventive Services LLC

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1326850587
  NPD (past)

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

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1154082907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 W PINE ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202435",
            "telephone_number": "309-224-0607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2426 W CORNERSTONE CT STE 100",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142400",
            "telephone_number": "309-966-3137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLOWAY",
        "first_name": "MARIAH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-04",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209024007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirbie E Holland, APN
• Dustin Holley, MS, ATC
• Tierra Holley
• Hollis Cons School Dist 328
• Jamie L Hollis, MA
• Michael Holloway
• Christopher P Holly, LCSW
• Benjamin M Holman, P.A.
• Michele Joey Holman, LCSW
• Aaron Coleman Holmes, O.D.

• All providers in Peoria, IL
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; 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.