Provider Demographics
NPI:1609897743
Name:HOLTON, CHERYL A (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:HOLTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-9301
Mailing Address - Country:US
Mailing Address - Phone:802-851-0999
Mailing Address - Fax:
Practice Address - Street 1:109 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-9301
Practice Address - Country:US
Practice Address - Phone:802-851-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0011324163WD0400X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP0316Medicaid
VT00028052OtherBLUE SHIELD
VT11V105OtherMVP
VT4647901OtherVERMONT MANAGED CARE
VT500002168OtherTRAVELERS MEDICARE
VT762143OtherCIGNA
VT00028052OtherBLUE SHIELD
VT11V105OtherMVP