Healthcare Provider Details

I. General information

NPI: 1871407866
Provider Name (Legal Business Name): MYESHIA NATAVIA HOLLOWAY CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 CASTLE HILL DR
JACKSON MS
39204-5232
US

IV. Provider business mailing address

2330 CASTLE HILL DR
JACKSON MS
39204-5232
US

V. Phone/Fax

Practice location:
  • Phone: 601-966-4638
  • Fax:
Mailing address:
  • Phone: 601-966-4638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number504203
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number504203
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number504203
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number504203
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: