Healthcare Provider Details

I. General information

NPI: 1558271809
Provider Name (Legal Business Name): SHEKELIA HOLLIDAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18373 HIGHWAY 39 N
DE KALB MS
39328-8247
US

IV. Provider business mailing address

18373 HIGHWAY 39 N
DE KALB MS
39328-8247
US

V. Phone/Fax

Practice location:
  • Phone: 601-663-9394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908780
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: