Provider Demographics
NPI:1326261199
Name:HOLLOWAY, JESSICA LEE (PA, RN, EMT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PA, RN, EMT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:PITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, EMT
Mailing Address - Street 1:4301 W MARKHAM ST # 508
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7199
Mailing Address - Country:US
Mailing Address - Phone:501-526-0759
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 508
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-526-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant