Provider Demographics
NPI:1730607672
Name:JOHNSTON, HOLLI KERVIN (NP)
Entity type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:KERVIN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:HOLLI
Other - Middle Name:KERVIN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6490 MEMPHIS ARLINGTON RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-7439
Mailing Address - Country:US
Mailing Address - Phone:901-762-1531
Mailing Address - Fax:901-762-1532
Practice Address - Street 1:2 BELLA GROVE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-603-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00000000000000363L00000X
TN23571363LF0000X
SC28838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner