Provider Demographics
NPI:1407836802
Name:HOLMAN, CAROLYN FAIRCLOTH (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:FAIRCLOTH
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ELIZABETH
Other - Last Name:FAIRCLOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:24980 STATE ST
Mailing Address - Street 2:PO DRAWER 519
Mailing Address - City:ELBERTA
Mailing Address - State:AL
Mailing Address - Zip Code:36530-2573
Mailing Address - Country:US
Mailing Address - Phone:251-986-7301
Mailing Address - Fax:251-986-5927
Practice Address - Street 1:24980 STATE ST
Practice Address - Street 2:PO DRAWER 519
Practice Address - City:ELBERTA
Practice Address - State:AL
Practice Address - Zip Code:36530-2573
Practice Address - Country:US
Practice Address - Phone:251-986-7301
Practice Address - Fax:251-986-5927
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1023686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51051740OtherBCBS-AL
AL00051740Medicaid
ALP00289187OtherRAILROAD MEDICARE
AL51051740OtherBCBS-AL
ALP00289187OtherRAILROAD MEDICARE