Provider Demographics
NPI:1558138420
Name:HOLT, MELISSA ANN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
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 1:502 N HOYT ST
Mailing Address - Street 2:
Mailing Address - City:KINTA
Mailing Address - State:OK
Mailing Address - Zip Code:74552-3073
Mailing Address - Country:US
Mailing Address - Phone:918-218-8742
Mailing Address - Fax:
Practice Address - Street 1:502 N HOYT ST
Practice Address - Street 2:
Practice Address - City:KINTA
Practice Address - State:OK
Practice Address - Zip Code:74552-3073
Practice Address - Country:US
Practice Address - Phone:918-218-8742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator