Provider Demographics
NPI:1063487890
Name:HOLDEN, RONNITA EVETTE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RONNITA
Middle Name:EVETTE
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:55 WESTOVER CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-0605
Mailing Address - Country:US
Mailing Address - Phone:919-935-0939
Mailing Address - Fax:
Practice Address - Street 1:181 MITTIE HADDOCK DR
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-9379
Practice Address - Country:US
Practice Address - Phone:919-842-5566
Practice Address - Fax:919-375-2048
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0000456363A00000X
VA0110001887363A00000X
MDC0002942363A00000X
NC0010-00759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant