MEDICARE: MISTY LYNNE HOLCOMB NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-092629	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PENDING	OTHER	AL	AL BCBS

General Provider Information

NPI Number	:	1912154956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY LYNNE HOLCOMB NP

Provider Business Mailing Address
First Line	:	2425 HIGHWAY 77
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-7907
Country	:	US
Telephone Number	:	256-442-4141
Fax Number	:	256-442-4157

Provider Business Practice Location Address
First Line	:	2425 HIGHWAY 77
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-7907
Country	:	US
Telephone Number	:	256-442-4141
Fax Number	:	256-442-4157

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	10/01/2020

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