Healthcare Provider Details

I. General information

NPI: 1699786681
Provider Name (Legal Business Name): TRACIE MICHELE DEJARNETTE-HOLLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ALMADEN BLVD STE 600
SAN JOSE CA
95113-1605
US

IV. Provider business mailing address

1607 WOOD SONG DR
SUGAR LAND TX
77479-6492
US

V. Phone/Fax

Practice location:
  • Phone: 256-500-8688
  • Fax:
Mailing address:
  • Phone: 281-804-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberK9516
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberK9516
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberK9516
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: