Provider Demographics
NPI:1205139698
Name:HOLLOWAY, KRISTY LEANN (RN)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LEANN
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 ESSARY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:TN
Mailing Address - Zip Code:38061-5633
Mailing Address - Country:US
Mailing Address - Phone:731-609-2086
Mailing Address - Fax:731-376-1245
Practice Address - Street 1:10825 OLD HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-3599
Practice Address - Country:US
Practice Address - Phone:731-658-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN125285163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse