Brondwyn Holliway, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

021100 Issued in LA

Practice address

3824 Hearne Ave
Shreveport, LA 71103-4328

Phone

(318) 635-8606

Fax

(318) 635-1265

NPI assigned

Mar 13, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Holliway Medical Clinic LLC

  • Pediatrics Physician
  • Shreveport, LA
  • NPI 1891833869
  NPD (past) Authorized official

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790818359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3824 HEARNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034328",
            "telephone_number": "318-635-8606",
            "fax_number": "318-635-1265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3824 HEARNE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034328",
            "telephone_number": "318-635-8606",
            "fax_number": "318-635-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIWAY",
        "first_name": "BRONDWYN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "021100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1966207",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NUMBER",
            "identifier": "1449423",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Hollis, M.A.
• Keriann Hollis, PLPC
• Sheila Hollis
• Anne M Hollister, M.D.
• Holliway Medical Clinic LLC
• Linda Holloway, CCC-SLP
• Matthew Braxton Hollowell, RT(R)
• Holly D. Casey, MD, a Professional Medical Corp
• Holly D. Casey, MD. a Professional Medical Corp.
• Latasha Nicole Holly, M.A.

• Pediatrics Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.