Healthcare Provider Details

I. General information

NPI: 1841971421
Provider Name (Legal Business Name): MS. BRANDI MICHELLE HOLLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MAIN ST S STE A
WEDOWEE AL
36278-7440
US

IV. Provider business mailing address

1030 MAIN ST S STE A
WEDOWEE AL
36278-7440
US

V. Phone/Fax

Practice location:
  • Phone: 256-357-2188
  • Fax: 256-357-2023
Mailing address:
  • Phone: 256-357-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-102065
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: