Provider Demographics
NPI:1760544621
Name:HOLMES, MICHAEL DAVIS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVIS
Last Name:HOLMES
Suffix:
Gender:M
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 1:415A N ROANE ST
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2024
Mailing Address - Country:US
Mailing Address - Phone:865-203-1039
Mailing Address - Fax:865-285-9150
Practice Address - Street 1:415A N ROANE ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2024
Practice Address - Country:US
Practice Address - Phone:865-203-1039
Practice Address - Fax:865-285-9150
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007808363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3648351Medicaid
TN3648351Medicaid
TN36483511Medicare PIN