Provider Demographics
NPI:1316500887
Name:WALDRON, HOLLIE (NP)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:WALDRON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:408 COUNCIL CIR STE C
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4949
Mailing Address - Country:US
Mailing Address - Phone:662-377-7546
Mailing Address - Fax:662-377-6330
Practice Address - Street 1:499 GLOSTER CREEK VLG STE S-2
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4600
Practice Address - Country:US
Practice Address - Phone:662-377-6331
Practice Address - Fax:662-377-6330
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS903242363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology