Individual
BRANDON HOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPAS, PA-C
Contact information
Practice address
2434 S EASON BLVD, TUPELO, MS 38804-6942
(662) 528-4349
(662) 680-6416
Mailing address
2434 S EASON BLVD, TUPELO, MS 38804-6942
(662) 640-4595
(662) 680-6416
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
363A00000X
Physician Assistant
Primary
PA00433
MS
363A00000X
Physician Assistant
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018203
—
MS
Enumeration date
05/26/2015
Last updated
09/18/2019
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