Provider Demographics
NPI:1639740509
Name:HOLLY, JENNIFER LEANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEANN
Last Name:HOLLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1227 N STATE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2002
Mailing Address - Country:US
Mailing Address - Phone:601-355-2485
Mailing Address - Fax:
Practice Address - Street 1:2969 CURRAN DR N STE 200
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4121
Practice Address - Country:US
Practice Address - Phone:601-974-5600
Practice Address - Fax:601-974-5699
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS904726363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner