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General NPI Number Information
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NPI Number | 1922713544
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Entity Type | Organization
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Legal Business Name | ONSITE HOUSE CALL CLINIC
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 02/05/2023
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Provider Practice Location Address
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Address Line | 40114 GRUBB SPRINGS RD
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City | HAMILTON
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State | MS
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Zip | 39746-9616
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Country | US
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Telephone | 662-356-1511
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Fax | 662-356-1711
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Provider Business Mailing Address
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Address Line | 40114 GRUBB SPRINGS RD
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City | HAMILTON
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State | MS
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Zip | 39746-9616
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Country | US
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Telephone | 662-356-1511
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Fax | 662-356-1711
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Authorized Official
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Title or Position | DIRECTOR
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Name | HEATHER LEIGH HOLLOWAY
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Credential | NP
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Telephone | 662-801-2826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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