Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R847138 | MS |
NPI | 1003045410 |
---|---|
Provider Name | Mrs. Patsy Lenan Holloway |
First Address | Quitman, MS 39355-2432 |
Second Address | Quitman, MS 39355-2331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 07/07/2009 |