Healthcare Provider Details

I. General information

NPI: 1144130493
Provider Name (Legal Business Name): JAQUARIAH EMONI HOLLIDAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1314 19TH AVE
MERIDIAN MS
39301-4116
US

IV. Provider business mailing address

893 HIGHWAY 45
PORTERVILLE MS
39352-6842
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-4362
  • Fax:
Mailing address:
  • Phone: 662-883-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908779
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: