Kaleab Mycheal Damien Hubbard-Holden, PTA

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

A7216 Issued in NC

Practice address

167 Moore Rd Ste 203
King, NC 27021-8770

Phone

(336) 673-6490

NPI assigned

Jun 28, 2022

Last updated

Aug 12, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1174255210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 MOORE RD STE 203",
            "city": "KING",
            "state": "NC",
            "postal_code": "270218770",
            "telephone_number": "336-673-6490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 MOORE RD STE 203",
            "city": "KING",
            "state": "NC",
            "postal_code": "270218770",
            "telephone_number": "336-673-6490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUBBARD-HOLDEN",
        "first_name": "KALEAB",
        "middle_name": "MYCHEAL DAMIEN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-08-12",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NC",
            "license": "A7216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://iconnect.novanthealth.org/Pages/Home.aspx",
            "affiliation": "N",
            "endpointDescription": "Messaging App",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Messaging /",
            "address_1": "167 Moore Rd Ste 203",
            "city": "King",
            "state": "NC",
            "country_code": "US",
            "postal_code": "270218770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katelyn Joyce Henderson, D.D.S.
• Natasha Shurketra Hjorth, LCMHC, LCAS-A
• Ashley Nicole Holder, NP-C
• Grace Victoria Hollifield, OTR/L
• Rebecca Frasher Horton, RN
• Tonya Teague Hughes, PHARMD
• Instride Foot and Ankle Specialists, PLLC
• Rebecca Kaye Jackson, MSW, LCSW
• Deborah Jackson James
• Kathryn Diane Janke, OTR/L

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in King, NC
• Providers in King, NC by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.