Provider Demographics
NPI:1003275199
Name:HOLT, MARYKAY (ARNP)
Entity Type:Individual
Prefix:
First Name:MARYKAY
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 CORPORATE PARK DR STE 200&300
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7133
Practice Address - Country:US
Practice Address - Phone:704-235-9090
Practice Address - Fax:704-235-9101
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1292862363LF0000X
NC5011662363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIM305YMedicare PIN
FLIM305XMedicare PIN
FLIM305ZMedicare PIN