Provider Demographics
NPI:1538216809
Name:HOLCOMB, KYLA M (CFNP)
Entity type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:M
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-3245
Mailing Address - Country:US
Mailing Address - Phone:662-378-9191
Mailing Address - Fax:662-378-5353
Practice Address - Street 1:1315 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3245
Practice Address - Country:US
Practice Address - Phone:662-378-9191
Practice Address - Fax:662-378-5353
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR782696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06854036Medicaid
MS500000334Medicare ID - Type Unspecified
MS06854036Medicaid