Healthcare Provider Details

I. General information

NPI: 1407991086
Provider Name (Legal Business Name): ROCKY HOLMES FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MARKET ST
FLOWOOD MS
39232-3339
US

IV. Provider business mailing address

3856 HWY 57 WEST PO BOX 99
RAMER TN
38367
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9276
  • Fax: 337-943-0846
Mailing address:
  • Phone: 731-645-6118
  • Fax: 731-645-8312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN8335
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR685993
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: