Provider Demographics
NPI:1639821614
Name:HOLLOWAY, RACHEL LYN (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 LYNCH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-6228
Mailing Address - Country:US
Mailing Address - Phone:423-377-8139
Mailing Address - Fax:
Practice Address - Street 1:633 LYNCH HOLLOW RD
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-6228
Practice Address - Country:US
Practice Address - Phone:423-377-8139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant