Provider Demographics
NPI:1053734681
Name:HOLLAWAY, EMILY HATCH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:HATCH
Last Name:HOLLAWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9126 S BRADEN PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4030
Mailing Address - Country:US
Mailing Address - Phone:918-521-7202
Mailing Address - Fax:
Practice Address - Street 1:9716 RIVERSIDE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7450
Practice Address - Country:US
Practice Address - Phone:918-299-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant