Provider Demographics
NPI:1558734749
Name:HOLT, MELISSA (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 CLINT WALKER RD
Mailing Address - Street 2:
Mailing Address - City:SIEPER
Mailing Address - State:LA
Mailing Address - Zip Code:71472-9706
Mailing Address - Country:US
Mailing Address - Phone:318-613-6209
Mailing Address - Fax:
Practice Address - Street 1:406 W FERTITTA BLVD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4649
Practice Address - Country:US
Practice Address - Phone:337-238-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN101273163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health