Provider Demographics
NPI:1841971421
Name:HOLLOWAY, BRANDI MICHELLE
Entity type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:MICHELLE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MAIN ST S STE A
Mailing Address - Street 2:
Mailing Address - City:WEDOWEE
Mailing Address - State:AL
Mailing Address - Zip Code:36278-7440
Mailing Address - Country:US
Mailing Address - Phone:256-357-2188
Mailing Address - Fax:
Practice Address - Street 1:1030 MAIN ST S STE A
Practice Address - Street 2:
Practice Address - City:WEDOWEE
Practice Address - State:AL
Practice Address - Zip Code:36278-7440
Practice Address - Country:US
Practice Address - Phone:256-357-2188
Practice Address - Fax:256-357-2023
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF06230472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily