Provider Demographics
NPI:1598326233
Name:SHOURD, HOLLY BROOKE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:BROOKE
Last Name:SHOURD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:BROOKE
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1359 W MARKET ST.
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008
Mailing Address - Country:US
Mailing Address - Phone:731-361-1003
Mailing Address - Fax:
Practice Address - Street 1:1359 W MARKET ST.
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008
Practice Address - Country:US
Practice Address - Phone:731-361-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000025929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine