Kerry L. Holland, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

P0000002099 Issued in TN

Practice address

807 University Pkwy
139 Lucille Clement Hall
Johnson City, TN 37614-6500

Phone

(423) 439-7778

Fax

(423) 439-7780

NPI assigned

Feb 10, 2006

Last updated

Jul 18, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Etsu Behavioral Health and Wellness Clinic

  • Community/Behavioral Health Agency
  • Johnson City, TN
  • NPI 1073872776
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342569600000",
    "number": "1811960644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 UNIVERSITY PKWY",
            "address_2": "BOX 70416, ETSU",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376146500",
            "telephone_number": "423-439-7778",
            "fax_number": "423-439-7780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 UNIVERSITY PKWY",
            "address_2": "139 LUCILLE CLEMENT HALL",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376146500",
            "telephone_number": "423-439-7778",
            "fax_number": "423-439-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "KERRY",
        "middle_name": "L.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-10",
        "last_updated": "2012-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "P0000002099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John L Holbrook, M.D.
• Robert David Holbrook, PHARMD
• Jessica Fay Holderness, PHARMD
• Caroline Reagan Holland, MASTER OF SCIENCE
• David W Holland, BS
• Meghan Marie Hollier, PMHNP
• Tangelia Lashan Hollingsworth
• Paula Vanessa Holloway, MED LMFT
• Shannon Hollowell, FNP
• Cynthia Hollows, RDH

• Clinical Psychologist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Clinical Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.