Provider Demographics
NPI:1821243924
Name:RIGDON, HOLLY C (NP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:C
Last Name:RIGDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MS
Mailing Address - Zip Code:39341-0466
Mailing Address - Country:US
Mailing Address - Phone:662-738-5454
Mailing Address - Fax:662-738-5457
Practice Address - Street 1:75 MS HWY 388
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39739
Practice Address - Country:US
Practice Address - Phone:662-738-5454
Practice Address - Fax:662-738-5457
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL120496Medicaid
MS00608592Medicaid