Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0000001389 | TN |
Y | 213ES0000X | Sports Medicine | 0000001389 | TN |
NPI | 1114495819 |
---|---|
Provider Name | Jesseca Holcomb |
First Address | Memphis, TN 38112-1624 |
Second Address | Memphis, TN 38112-1624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2018 |
Last Update Date | 12/11/2018 |