Healthcare Provider Details

I. General information

NPI: 1275057523
Provider Name (Legal Business Name): ALEXANDRIA GRACE-MARY HOLDER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRIA GRACE-MARY LOGAN

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 W MORRIS BLVD
MORRISTOWN TN
37813-2837
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-3904
  • Fax: 833-908-2160
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-381-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number22875
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: