MEDICARE: TONIA HOLLEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R823713	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R823713	OTHER	MS	LICENSE

General Provider Information

NPI Number	:	1164727269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONIA HOLLEY NP

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:
City	:	LAUREL
State	:	MS
Zip	:	39441-0247
Country	:	US
Telephone Number	:	601-425-7550
Fax Number	:	601-399-6184

Provider Business Practice Location Address
First Line	:	1122 E MAIN ST
Second Line	:	SUITE 4
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-2348
Country	:	US
Telephone Number	:	601-656-1001
Fax Number	:	601-656-7555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	11/16/2020

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Directions to “ TONIA HOLLEY NP” Practice Location

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