Healthcare Provider Details

I. General information

NPI: 1942840368
Provider Name (Legal Business Name): ADDIE HOLLEMAN HOLCOMB NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 13TH ST
GULFPORT MS
39501-2515
US

IV. Provider business mailing address

4500 13TH ST
GULFPORT MS
39501-2515
US

V. Phone/Fax

Practice location:
  • Phone: 228-575-1800
  • Fax: 228-865-3038
Mailing address:
  • Phone: 228-867-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number886309
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number903801
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: