Provider Demographics
NPI:1447205588
Name:HOLMAN, JULIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:270-766-1222
Practice Address - Street 1:1311 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2621
Practice Address - Country:US
Practice Address - Phone:270-769-1304
Practice Address - Fax:270-234-8028
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY330122084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000282801OtherANTHEM
11386142OtherCAQH
KY228317OtherTRICARE
KY30605018Medicaid
KY0359255Medicare ID - Type UnspecifiedMEDICARE
11386142OtherCAQH
KY0358656Medicare ID - Type UnspecifiedMEDICARE
KY228317OtherTRICARE
KY0762328Medicare ID - Type UnspecifiedMEDICARE
KY30605018Medicaid
KY000000282801OtherANTHEM
KY0359057Medicare ID - Type UnspecifiedMEDICARE
0690905Medicare ID - Type Unspecified
KY0358957Medicare ID - Type UnspecifiedMEDICARE