Active NPI
Kelli Lea Holloway, M.D.
- Professional Counselor
- Portland, OR
National Provider Identifier
1548408206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- MD23361
- Practice address
- 4800 SW Macadam Avenue
Suite 325
Portland, OR 97239-3927 - Phone
- (503) 295-7900
- Fax
- (503) 224-8883
- NPI assigned
- Feb 3, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | MD23361 | OR | Primary |
Addresses
Primary practice location
4800 SW Macadam Avenue
Suite 325
Portland, OR 97239-3927
Mailing address
4800 S.W. Macadam Avenue
Suite 325
Portland, OR 97239-3927
Phone (503) 295-7900
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2015 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD23361 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233619200000",
"number": "1548408206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4800 S.W. MACADAM AVENUE",
"address_2": "SUITE 325",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393927",
"telephone_number": "503-295-7900",
"fax_number": "503-224-8883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 SW MACADAM AVENUE",
"address_2": "SUITE 325",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972393927",
"telephone_number": "503-295-7900",
"fax_number": "503-224-8883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLOWAY",
"first_name": "KELLI",
"middle_name": "LEA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-03",
"last_updated": "2009-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "MD23361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.