Provider Demographics
NPI:1336678556
Name:MARK, RACHEL HOLMAN (MSN, RN, CPN,CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:HOLMAN
Last Name:MARK
Suffix:
Gender:F
Credentials:MSN, RN, CPN,CPNP-PC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6482
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-1475
Practice Address - Fax:682-885-7520
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP134322363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty