Provider Demographics
NPI:1598116402
Name:WILLIS, BRITTANY HOLLIDAY (FNP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:HOLLIDAY
Last Name:WILLIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4837 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:POPE
Mailing Address - State:MS
Mailing Address - Zip Code:38658-7245
Mailing Address - Country:US
Mailing Address - Phone:662-934-6516
Mailing Address - Fax:
Practice Address - Street 1:171 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3011
Practice Address - Country:US
Practice Address - Phone:662-655-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily