Provider Demographics
NPI:1396176459
Name:HOLCOMBE, STEPHANIE JANE (RN, CNM, FNP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:JANE
Last Name:HOLCOMBE
Suffix:
Gender:F
Credentials:RN, CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 HIGHWAY 12 W # 333
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3582
Mailing Address - Country:US
Mailing Address - Phone:662-251-2328
Mailing Address - Fax:202-396-6953
Practice Address - Street 1:834 HIGHWAY 12 W # 333
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3582
Practice Address - Country:US
Practice Address - Phone:662-251-2328
Practice Address - Fax:202-396-6953
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901878363LF0000X
DCRN1032074367A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0918819Medicaid
DC03740930Medicaid