Provider Demographics
NPI:1992467898
Name:HOLLOWAY, MARCIA JONES (RN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:JONES
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:237 ZION HILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:MS
Mailing Address - Zip Code:39663-5001
Mailing Address - Country:US
Mailing Address - Phone:601-522-9535
Mailing Address - Fax:
Practice Address - Street 1:109 ELM AVE
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476-9042
Practice Address - Country:US
Practice Address - Phone:601-912-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS883795163W00000X
MS905877363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse