Provider Demographics
NPI:1124062930
Name:ARMSTRONG, HOLLY (NP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 EASTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-4223
Mailing Address - Country:US
Mailing Address - Phone:601-824-8938
Mailing Address - Fax:601-815-6986
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5160
Practice Address - Fax:601-815-6986
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR862270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04888590Medicaid
MS202011213AOtherBLUE CROSS
MS04888590Medicaid
MS302I505823Medicare PIN
MS500001763Medicare ID - Type Unspecified