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General NPI Number Information
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NPI Number | 1215379706
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Entity Type | Individual
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Provider Name | KRYSTLE E HOLLIDAY CFNP
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Gender | Female
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 587 S BELVEDERE BLVD
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City | MEMPHIS
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State | TN
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Zip | 38104-5002
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Country | US
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Telephone | 662-512-2428
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Fax |
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Provider Business Mailing Address
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Address Line | 7325 GREEN ASH DR
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-4383
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Country | US
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Telephone | 662-512-2428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A810521
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 19265
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License Number State | TN
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