Provider Demographics
NPI:1568813194
Name:MASSENGILL, HOLLY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:MASSENGILL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-4706
Mailing Address - Country:US
Mailing Address - Phone:865-357-5377
Mailing Address - Fax:865-537-5379
Practice Address - Street 1:1104 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-4706
Practice Address - Country:US
Practice Address - Phone:865-357-5377
Practice Address - Fax:865-537-5379
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000020080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily