1609187152 NPI number — REBECCA E HOLLINGSWORTH MSN, GNP-BC, FNP-BC

Table of content: REBECCA E HOLLINGSWORTH MSN, GNP-BC, FNP-BC (NPI 1609187152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609187152 NPI number — REBECCA E HOLLINGSWORTH MSN, GNP-BC, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLINGSWORTH
Provider First Name:
REBECCA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, GNP-BC, FNP-BC
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:
1609187152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 YELLOW PINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PETAL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39465-9558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-270-4476
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 RAWLS SPRINGS LOOP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATTIESBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39402-7801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-582-6069
Provider Business Practice Location Address Fax Number:
601-579-4842
Provider Enumeration Date:
06/30/2010

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: 207QG0300X , with the licence number:  R790914 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01671306 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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