Provider Demographics
NPI:1053050161
Name:HOLT, ANGEL
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:HOLT
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-0188
Mailing Address - Country:US
Mailing Address - Phone:304-782-2190
Mailing Address - Fax:
Practice Address - Street 1:2265 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426-7615
Practice Address - Country:US
Practice Address - Phone:304-782-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant