Provider Demographics
NPI:1871236414
Name:ROBERSON, HOLLY DAWN (FNP-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:DAWN
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MAYPEARL
Mailing Address - State:TX
Mailing Address - Zip Code:76064-2029
Mailing Address - Country:US
Mailing Address - Phone:214-632-6807
Mailing Address - Fax:
Practice Address - Street 1:2715 BOLTON BOONE DR STE A
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2079
Practice Address - Country:US
Practice Address - Phone:972-636-4468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily