Active NPI
Carolyn Holloway
- Psychiatric/Mental Health Nurse Practitioner
- Jackson, MS
National Provider Identifier
1144656927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- R723428
- Practice address
- 3450 Highway 80 W
Jackson, MS 39209-7201 - Phone
- (601) 321-2497
- Fax
- (601) 321-2476
- NPI assigned
- Sep 24, 2013
- Last updated
- Oct 30, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R723428 | MS | Primary |
Addresses
Primary practice location
3450 Highway 80 W
Jackson, MS 39209-7201
Mailing address
3450 Highway 80 W
Jackson, MS 39209-7201
Phone (601) 321-2497
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00018209 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R723428 | MS | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383091200000",
"number": "1144656927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3450 HIGHWAY 80 W",
"city": "JACKSON",
"state": "MS",
"postal_code": "392097201",
"telephone_number": "601-321-2497",
"fax_number": "601-321-2476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3450 HIGHWAY 80 W",
"city": "JACKSON",
"state": "MS",
"postal_code": "392097201",
"telephone_number": "601-321-2497",
"fax_number": "601-321-2476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLOWAY",
"first_name": "CAROLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-24",
"last_updated": "2013-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "MS",
"license": "R723428",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00018209",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.