Healthcare Provider Details

I. General information

NPI: 1194064642
Provider Name (Legal Business Name): HOLLY V VANCE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY VANCE

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 STATE ST STE 3010
BRISTOL TN
37620-2260
US

IV. Provider business mailing address

516 HOLSTON AVE STE 202
BRISTOL TN
37620-2166
US

V. Phone/Fax

Practice location:
  • Phone: 423-217-0919
  • Fax: 765-601-6651
Mailing address:
  • Phone: 423-217-0919
  • Fax: 765-601-6651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number199974
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001127433
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024173751
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0017143055
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number21531
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: