# HOLLY JOHNSON LTC, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114426756
- **Authorized official:** HOLLY M AUGUSTUS FNP-C (OWNER/EMPLOYEE)
- **Authorized official phone:** (903) 721-0865

## Contact information

- **Practice address:** 5505 NEW COPELAND RD, TYLER, TX 75703-3955
- **Practice address phone:** (903) 705-0202
- **Mailing address:** 608 MONROE ST, JACKSONVILLE, TX 75766-4342
- **Mailing address phone:** (903) 721-0865

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | AP136353 | TX | Yes |

## Other

- **Enumeration date:** 02/09/2018
- **Last updated:** 06/14/2019