Provider Demographics
NPI:1053967745
Name:HOLLIDAY, REBECCA LYNN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6159 S KERR RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72142-9020
Mailing Address - Country:US
Mailing Address - Phone:501-944-0337
Mailing Address - Fax:
Practice Address - Street 1:6159 S KERR RD
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:AR
Practice Address - Zip Code:72142-9020
Practice Address - Country:US
Practice Address - Phone:501-837-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider