Individual
HOLLY REBECCA ETHEREDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
700 E MARSHALL AVE, LONGVIEW, TX 75601-5580
(903) 315-1500
Mailing address
3546 FM 959, BECKVILLE, TX 75631-6883
(936) 645-8598
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1099410
TX
363LA2100X
Acute Care Nurse Practitioner
1099410
TX
Other
Enumeration date
11/23/2022
Last updated
01/17/2023
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