MEDICARE: RENDA JOY HOLLADAY APRN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP115660	TX
2	363LF0000X	Family Nurse Practitioner	AP115660	TX

General Provider Information

NPI Number	:	1235321696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENDA JOY HOLLADAY APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	601 QUAIL VALLEY DR STE 121
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-8051
Country	:	US
Telephone Number	:	512-887-3444
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 QUAIL VALLEY DR
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-8051
Country	:	US
Telephone Number	:	512-887-3444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	08/19/2024

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