Provider Demographics
NPI:1790360287
Name:HOLLIE MOFFATT PMHNP-BC LLC
Entity Type:Organization
Organization Name:HOLLIE MOFFATT PMHNP-BC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-350-0760
Mailing Address - Street 1:315 MAGAZINE ST STE C
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4802
Mailing Address - Country:US
Mailing Address - Phone:662-350-0760
Mailing Address - Fax:
Practice Address - Street 1:315 MAGAZINE ST STE C
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4802
Practice Address - Country:US
Practice Address - Phone:662-350-0760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty