MEDICARE: DR. TRACIE MICHELE DEJARNETTE-HOLLY MD

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	2084F0202X	Forensic Psychiatry Physician	K9516	TX
2	2084P0800X	Psychiatry Physician	K9516	TX
3	2084P0804X	Child & Adolescent Psychiatry Physician	K9516	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699786681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACIE MICHELE DEJARNETTE-HOLLY MD

Provider Business Mailing Address
First Line	:	1607 WOOD SONG DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6492
Country	:	US
Telephone Number	:	281-804-2531
Fax Number	:

Provider Business Practice Location Address
First Line	:	22001 SOUTHWEST FWY STE 125
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-7002
Country	:	US
Telephone Number	:	832-219-3898
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	06/30/2023

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Directions to “ DR. TRACIE MICHELE DEJARNETTE-HOLLY MD” Practice Location

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