Healthcare Provider Details

I. General information

NPI: 1689234635
Provider Name (Legal Business Name): HOLLY WILLIAMS CUEVAS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 15TH ST STE A
GULFPORT MS
39501-2525
US

IV. Provider business mailing address

11775 HONEY BEAR LN
SAUCIER MS
39574-5007
US

V. Phone/Fax

Practice location:
  • Phone: 228-863-4000
  • Fax:
Mailing address:
  • Phone: 601-408-5987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903380
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: