Provider Demographics
NPI:1629793872
Name:HOLLADAY, AUBREY RICKARD (NP)
Entity type:Individual
Prefix:MRS
First Name:AUBREY
Middle Name:RICKARD
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:AUBREY
Other - Middle Name:ELIZABETH
Other - Last Name:RICKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2565 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-7150
Mailing Address - Country:US
Mailing Address - Phone:803-468-0712
Mailing Address - Fax:
Practice Address - Street 1:3180 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1811
Practice Address - Country:US
Practice Address - Phone:803-971-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26682363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily