Healthcare Provider Details

I. General information

NPI: 1003045410
Provider Name (Legal Business Name): PATSY LENAN HOLLOWAY FNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S ARCHUSA AVE
QUITMAN MS
39355-2331
US

IV. Provider business mailing address

503 LYNDA ST
QUITMAN MS
39355-2432
US

V. Phone/Fax

Practice location:
  • Phone: 601-776-6925
  • Fax: 601-776-7148
Mailing address:
  • Phone: 601-776-6925
  • Fax: 601-776-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR847138
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: