Provider Demographics
NPI:1932445277
Name:WILLOUGHBY, HOLLY (PNP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W ALABAMA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-1642
Mailing Address - Country:US
Mailing Address - Phone:256-891-1221
Mailing Address - Fax:
Practice Address - Street 1:104 W ALABAMA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1642
Practice Address - Country:US
Practice Address - Phone:256-891-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-132913363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics