Individual provider Active NPI

Mariah Carly Holst, NP

  • Acute Care Nurse Practitioner
  • Suffolk, VA
National Provider Identifier
1407771058
Registry record updated Sep 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
0024198442 Issued in VA
Practice address
2790 Godwin Blvd Ste 360
Suffolk, VA 23434-8153
Phone
(757) 261-8070
Fax
(757) 995-7095
NPI assigned
Aug 12, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 0024198442 VA
Adult Health Nurse Practitioner 363LA2200X 0024198442 VA
Acute Care Nurse Practitioner 363LA2100X 0024198442 VA Primary

Addresses

Primary practice location

2790 Godwin Blvd Ste 360
Suffolk, VA 23434-8153

Mailing address

2790 Godwin Blvd Ste 360
Suffolk, VA 23434-8153
Phone (757) 261-8070

Other practice location 1

709 Elderberry Ct
Chesapeake, VA 23320-9219
Phone (760) 333-6412

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1786492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790294400000",
    "number": "1407771058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 GODWIN BLVD STE 360",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348153",
            "telephone_number": "757-261-8070",
            "fax_number": "757-995-7095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 GODWIN BLVD STE 360",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348153",
            "telephone_number": "757-261-8070",
            "fax_number": "757-995-7095"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "709 Elderberry Ct",
            "address_purpose": "LOCATION",
            "city": "Chesapeake",
            "state": "VA",
            "postal_code": "233209219",
            "country_code": "US",
            "telephone_number": "760-333-6412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLST",
        "first_name": "MARIAH",
        "middle_name": "CARLY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-08-12",
        "last_updated": "2026-09-25",
        "certification_date": "2026-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "VA",
            "license": "0024198442",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024198442",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "VA",
            "license": "0024198442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.