Provider Demographics
NPI:1235512195
Name:HOLEMAN, AUDRA B (NP)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:B
Last Name:HOLEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:B
Other - Last Name:BECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1643 NW 136TH AVE
Mailing Address - Street 2:BLDG H STE 100 MSC 11607-0004
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2857
Mailing Address - Country:US
Mailing Address - Phone:865-500-1346
Mailing Address - Fax:865-560-7110
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-450-7466
Practice Address - Fax:812-450-4665
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28197688A163W00000X
TX1029833363L00000X
IN71005756A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201319420Medicaid
IN201319420Medicaid