Individual
HOLLY KEDDINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
105 HIGHLAND TER, WATERLOO, WI 53594-2217
(920) 478-2141
(920) 478-3820
Mailing address
105 HIGHLAND TER, WATERLOO, WI 53594-2217
(920) 478-2141
(920) 478-3820
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7947-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194458794
—
WI
Enumeration date
07/01/2022
Last updated
09/17/2024
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