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General NPI Number Information
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NPI Number | 1487668976
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Entity Type | Individual
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Provider Name | HOLLY VIRGINIA MACKENNA M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 2066 NC HIGHWAY 125
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City | ROANOKE RAPIDS
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State | NC
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Zip | 27870-9436
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Country | US
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Telephone | 252-536-5000
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Fax | 252-536-2258
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Provider Business Mailing Address
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Address Line | PO BOX 640
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City | ROANOKE RAPIDS
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State | NC
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Zip | 27870-0640
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Country | US
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Telephone | 252-536-5844
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Fax | 252-519-0154
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 19239
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 025358
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2025-02667
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License Number State | NC
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