Provider Demographics
NPI:1407576382
Name:HOLLY, REID ANDREW (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:REID
Middle Name:ANDREW
Last Name:HOLLY
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 FIELDSTONE LOOP
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3463
Mailing Address - Country:US
Mailing Address - Phone:601-331-3295
Mailing Address - Fax:
Practice Address - Street 1:2090 OLD TAYLOR RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5245
Practice Address - Country:US
Practice Address - Phone:601-366-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905504363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health