Provider Demographics
NPI:1346407574
Name:HOLT, WENDY NICOLE (MSN APRN BC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:NICOLE
Last Name:HOLT
Suffix:
Gender:F
Credentials:MSN APRN BC
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:NICOLE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7610 N STEMMONS FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4228
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:469-713-8084
Practice Address - Street 1:12200 PARK CENTRAL DR
Practice Address - Street 2:SUITE 403
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2100
Practice Address - Country:US
Practice Address - Phone:972-239-2400
Practice Address - Fax:972-239-2403
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118565363L00000X
TX780669363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L25043Medicare PIN
TXP00827097Medicare PIN