Healthcare Provider Details

I. General information

NPI: 1922713544
Provider Name (Legal Business Name): ONSITE HOUSE CALL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 02/05/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40114 GRUBB SPRINGS RD
HAMILTON MS
39746-9616
US

IV. Provider business mailing address

40114 GRUBB SPRINGS RD
HAMILTON MS
39746-9616
US

V. Phone/Fax

Practice location:
  • Phone: 662-356-1511
  • Fax: 662-356-1711
Mailing address:
  • Phone: 662-356-1511
  • Fax: 662-356-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HEATHER LEIGH HOLLOWAY
Title or Position: DIRECTOR
Credential: NP
Phone: 662-801-2826