Provider Demographics
NPI:1982618369
Name:HOLLIBAUGH, BECKY F (DO)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:F
Last Name:HOLLIBAUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5505
Mailing Address - Country:US
Mailing Address - Phone:228-456-0173
Mailing Address - Fax:228-456-0174
Practice Address - Street 1:3920 PROMENADE PKWY
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39540
Practice Address - Country:US
Practice Address - Phone:228-456-0173
Practice Address - Fax:228-456-0174
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47600054904Medicaid