Provider Demographics
NPI:1639407471
Name:HOLT, LAURA R (APN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:HOLT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HOSPITAL DR STE 260
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5027
Mailing Address - Country:US
Mailing Address - Phone:615-859-9902
Mailing Address - Fax:
Practice Address - Street 1:510 HOSPITAL DR STE 260
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5027
Practice Address - Country:US
Practice Address - Phone:615-859-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14592363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health