Individual
MR. HOLLIS LANGSTON PURVIANCE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CFNP
Contact information
Practice address
2500 N STATE ST, UNIVERSITY ORTHOPEDIC ASSOCIATES PLLC, JACKSON, MS 39216
(601) 984-1000
(601) 984-6533
Mailing address
2500 N STATE ST, CBO - SUITE 4200, JACKSON, MS 39216-4500
(601) 496-9794
(601) 815-0434
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R859975
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08425307
—
MS
01
—
512G700003
UNIVERSITY PHYSICIANS
MS
05
—
8425307
—
MS
01
—
P00618110
RR PTAN
MS
01
—
P01194846
RR MEDICARE PTAN
MS
Enumeration date
08/09/2006
Last updated
11/19/2019
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