Angelique Victoria Holley

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA228517 Issued in OR

Practice address

3896 Beverly Ave NE Ste 40
Salem, OR 97305-1374

Phone

(503) 588-0076

NPI assigned

Nov 7, 2024

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

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Yakima Valley Farm Workers Clinic

  • Federally Qualified Health Center (FQHC)
  • Hermiston, OR
  • NPI 1427001940
  Medicare reassignment NPD
• Yakima Valley Farm Workers Clinic

  • Federally Qualified Health Center (FQHC)
  • Clatskanie, OR
  • NPI 1578000345
  NPD
• George Fox University

  • Athletic Trainer
  • Newberg, OR
  • NPI 1770613036
  NPD (past)

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

{
    "created_epoch": "1730937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772409600000",
    "number": "1205659174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989480190",
            "telephone_number": "509-865-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3896 BEVERLY AVE NE STE 40",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973051374",
            "telephone_number": "503-588-0076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLEY",
        "first_name": "ANGELIQUE",
        "middle_name": "VICTORIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-07",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA228517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Holkenbrink
• Edward Lee Holland, RPH
• Jennifer Holland, CPM, LDM
• Nicholas Holland
• Nathan L Hollenbeck, R EEG T
• Logan Taelor Holley
• Nicole Ellen Hollow
• Fallon Holloway
• William David Holloway, MD
• Holly a Chamberlain DDS LLC

• Physician Assistant in Salem, OR
• Providers in Salem, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.