NPIMap

Individual provider Active NPI

Teresa A. Holler, P.A.

  • Medical Physician Assistant
  • Wilmington, NC
National Provider Identifier
1528247244
Registry record updated Jun 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0110002271 Issued in VA
Practice address
4000 Shipyard Blvd Ste 120
Wilmington, NC 28403-6194
Phone
(910) 473-3222
Fax
(910) 769-0063
NPI assigned
Oct 30, 2007
Last updated
Jun 4, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0110002271 VA Primary

Addresses

Primary practice location

4000 Shipyard Blvd Ste 120
Wilmington, NC 28403-6194

Mailing address

4000 Shipyard Blvd Ste 120
Wilmington, NC 28403-6194
Phone (910) 473-3222

Other practice location 1

127 McClanahan St SW
300
Roanoke, VA 24014
Phone (540) 982-8204

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jan 7, 2014 through Jan 7, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110002271VAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Medical Center Past Accepting new patients
Wilmington Cardiology PLLC Past Accepting new patients
Patient Centered Care, PLLC Past Accepting new patients
Insight Family Health Center, PLLC Past Accepting new patients
Physicians Care of Virginia PC Past Accepting new patients
Wilmington Health PLLC Past Accepting new patients

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528070400000",
    "number": "1528247244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 SHIPYARD BLVD STE 120",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036194",
            "telephone_number": "910-473-3222",
            "fax_number": "910-769-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 SHIPYARD BLVD STE 120",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036194",
            "telephone_number": "910-473-3222",
            "fax_number": "910-769-0063"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "127 McClanahan St SW",
            "address_2": "300",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "24014",
            "country_code": "US",
            "telephone_number": "540-982-8204",
            "fax_number": "540-527-1039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLLER",
        "first_name": "TERESA",
        "middle_name": "A.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-30",
        "last_updated": "2018-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.