Provider Demographics
NPI:1346676459
Name:HOLT, BELINDA GAIL
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:GAIL
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 1
Mailing Address - Street 2:
Mailing Address - City:CORDELL
Mailing Address - State:OK
Mailing Address - Zip Code:73632-0001
Mailing Address - Country:US
Mailing Address - Phone:580-660-0899
Mailing Address - Fax:580-323-3988
Practice Address - Street 1:814 W GARY BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-2720
Practice Address - Country:US
Practice Address - Phone:580-660-0899
Practice Address - Fax:580-323-3988
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6060228OtherNPN
OK80213OtherINSURANCE