Deidra Diane Holland, LPN

Key facts

NPI

1154891828

Entity type

Individual (NPI type 1)

Primary specialty

Licensed Practical Nurse 164W00000X

License

83171 (TN)

Practice address

90 Rush St
Lexington, TN 38351-2241

Phone

(731) 968-8148

Fax

(731) 968-4777

NPI assigned

Nov 26, 2018

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 26, 2018.

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1154891828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 RUSH ST",
            "city": "LEXINGTON",
            "state": "TN",
            "postal_code": "383512241",
            "telephone_number": "731-968-8148",
            "fax_number": "731-968-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 RUSH ST",
            "city": "LEXINGTON",
            "state": "TN",
            "postal_code": "383512241",
            "telephone_number": "731-968-8148",
            "fax_number": "731-968-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "DEIDRA",
        "middle_name": "DIANE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-26",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TN",
            "license": "83171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Lexington, TN · Licensed Practical Nurse in Tennessee