Provider Demographics
NPI:1962013664
Name:MOFFATT, HOLLIE DULANEY (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:DULANEY
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N LANE DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4500
Mailing Address - Country:US
Mailing Address - Phone:662-871-2897
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:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904051363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health