Provider Demographics
NPI:1184170086
Name:SMITH, HOLLEY HARRIS (FNP-BC)
Entity type:Individual
Prefix:
First Name:HOLLEY
Middle Name:HARRIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HOLLEY
Other - Middle Name:KAYE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:186 BETT RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-5236
Mailing Address - Country:US
Mailing Address - Phone:662-288-3440
Mailing Address - Fax:
Practice Address - Street 1:186 BETT RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MS
Practice Address - Zip Code:38618-5236
Practice Address - Country:US
Practice Address - Phone:662-288-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901745163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse