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General NPI Number Information
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NPI Number | 1407576382
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Entity Type | Individual
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Provider Name | REID ANDREW HOLLY PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 2889 S LAMAR BLVD
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City | OXFORD
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State | MS
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Zip | 38655-5433
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Country | US
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Telephone | 662-272-1001
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Fax | 866-228-7940
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Provider Business Mailing Address
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Address Line | 4 COUNTY ROAD 3012
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City | WATER VALLEY
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State | MS
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Zip | 38965-3891
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Country | US
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Telephone | 601-331-3295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 905504
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License Number State | MS
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