Provider Demographics
NPI:1134842099
Name:HOLLIDAY, KIMBERLY ANNETTE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNETTE
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HASTINGS PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1698
Mailing Address - Country:US
Mailing Address - Phone:904-585-5166
Mailing Address - Fax:
Practice Address - Street 1:250 N PARKWAY STE 28
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2754
Practice Address - Country:US
Practice Address - Phone:901-585-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy