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General NPI Number Information
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NPI Number | 1790360287
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Entity Type | Organization
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Legal Business Name | HOLLIE MOFFATT PMHNP-BC LLC
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 315 MAGAZINE ST STE C
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City | TUPELO
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State | MS
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Zip | 38804-4802
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Country | US
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Telephone | 662-350-0760
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Fax |
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Provider Business Mailing Address
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Address Line | 315 MAGAZINE ST STE C
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City | TUPELO
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State | MS
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Zip | 38804-4802
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Country | US
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Telephone | 662-350-0760
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HOLLIE MOFFATT
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Credential |
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Telephone | 662-350-0760
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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 |
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License Number State |
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