Provider Demographics
NPI:1215379706
Name:HOLLIDAY, KRYSTLE E (CFNP)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:E
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 GREEN ASH DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-4383
Mailing Address - Country:US
Mailing Address - Phone:662-512-2428
Mailing Address - Fax:
Practice Address - Street 1:587 S BELVEDERE BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5002
Practice Address - Country:US
Practice Address - Phone:662-512-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810521363LF0000X
TN19265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily