Healthcare Provider Details

I. General information

NPI: 1295763316
Provider Name (Legal Business Name): HOLLY DAWN WALKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 TOMBRAS AVE
EAST RIDGE TN
37412-2720
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 423-867-4969
  • Fax: 423-867-4971
Mailing address:
  • Phone: 615-239-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12013
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: