Provider Demographics
NPI:1609187152
Name:HOLLINGSWORTH, REBECCA E (MSN, GNP-BC, FNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:MSN, GNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 YELLOW PINE DR
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-9558
Mailing Address - Country:US
Mailing Address - Phone:601-270-4476
Mailing Address - Fax:
Practice Address - Street 1:20 RAWLS SPRINGS LOOP RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7801
Practice Address - Country:US
Practice Address - Phone:601-582-6069
Practice Address - Fax:601-579-4842
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR790914207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01671306Medicaid