Provider Demographics
NPI:1811306533
Name:MCCLAIN, HOLLI LYNN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:HOLLI
Middle Name:LYNN
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HOLLI
Other - Middle Name:LYNN
Other - Last Name:WITHROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:
Practice Address - Street 1:125 MAIN STREET MARKET
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-3307
Practice Address - Country:US
Practice Address - Phone:770-606-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV78144163W00000X
WVAPRN78144-FNP-BC363LF0000X
GARN276451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1811306533Medicaid
WVB441OtherMEDICARE GROUP
WV1811306533Medicaid
WVWV5748B441Medicare PIN