Provider Demographics
NPI:1194072397
Name:DAVIS, HOLLYE CARSON (RN, BSN)
Entity type:Individual
Prefix:
First Name:HOLLYE
Middle Name:CARSON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:HOLLYE
Other - Middle Name:KATHLEEN
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:1269 PERKINS TERRACE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117
Mailing Address - Country:US
Mailing Address - Phone:901-552-7442
Mailing Address - Fax:
Practice Address - Street 1:1269 PERKINS TER
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-6011
Practice Address - Country:US
Practice Address - Phone:901-552-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000151730163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse