Basic Information
| Provider Information | |||||||||
| NPI: | 1598326233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOURD | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | BROOKE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HENSON | ||||||||
| OtherFirstName: | HOLLY | ||||||||
| OtherMiddleName: | BROOKE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1359 W MARKET ST. | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7313611003 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1359 W MARKET ST. | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7313611003 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2019 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | APN0000025929 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.