Healthcare Provider Details

I. General information

NPI: 1164727269
Provider Name (Legal Business Name): TONIA HOLLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 E MAIN ST SUITE 4
PHILADELPHIA MS
39350-2348
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-656-1001
  • Fax: 601-656-7555
Mailing address:
  • Phone: 601-425-7550
  • Fax: 601-399-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR823713
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: