Provider Demographics
NPI:1053065730
Name:HOLCOMB, KEISHA LAJEAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:LAJEAN
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-308-0280
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:1651 GUNBARREL RD STE 201
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3291
Practice Address - Country:US
Practice Address - Phone:423-899-9133
Practice Address - Fax:423-855-8176
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000672363LF0000X
TN133484363LF0000X
TN31307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily