Provider Demographics
NPI:1063042448
Name:HOLLIMAN, CODY LEE (CRNA)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:LEE
Last Name:HOLLIMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 OLD HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:MC HENRY
Mailing Address - State:MS
Mailing Address - Zip Code:39561-6176
Mailing Address - Country:US
Mailing Address - Phone:228-731-8750
Mailing Address - Fax:
Practice Address - Street 1:600 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2235
Practice Address - Country:US
Practice Address - Phone:361-881-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS126454367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered