1487668976 NPI number — DR. HOLLY VIRGINIA MACKENNA M.D.

Table of content: DR. HOLLY VIRGINIA MACKENNA M.D. (NPI 1487668976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487668976 NPI number — DR. HOLLY VIRGINIA MACKENNA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACKENNA
Provider First Name:
HOLLY
Provider Middle Name:
VIRGINIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487668976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7738 PLUM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70118-4036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-338-8340
Provider Business Mailing Address Fax Number:
504-364-4077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4422 GENERAL MEYER AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70131-3588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-376-5777
Provider Business Practice Location Address Fax Number:
504-364-4077
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  19239 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 025358 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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