Provider Demographics
NPI:1558996280
Name:HOLDER, BRIANNA
Entity Type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4006
Mailing Address - Country:US
Mailing Address - Phone:731-407-7562
Mailing Address - Fax:731-407-7455
Practice Address - Street 1:216 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4006
Practice Address - Country:US
Practice Address - Phone:731-407-7562
Practice Address - Fax:731-407-7455
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000000026033253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care