Provider Demographics
NPI:1073854626
Name:HOLLIMON, MEGHAN PACE (CRNP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:PACE
Last Name:HOLLIMON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1218
Mailing Address - Country:US
Mailing Address - Phone:256-974-2200
Mailing Address - Fax:
Practice Address - Street 1:1103 16TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3595
Practice Address - Country:US
Practice Address - Phone:256-350-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-131449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily