Provider Demographics
NPI:1659395960
Name:HOLT, BILLY (DO)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:
Last Name:HOLT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 N DEFFER DR
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8438
Mailing Address - Country:US
Mailing Address - Phone:417-595-7826
Mailing Address - Fax:
Practice Address - Street 1:1868 N DEFFER DR
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8438
Practice Address - Country:US
Practice Address - Phone:417-595-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006019876207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006019876OtherSTATE MEDICAL LICENSE
MO1659395960Medicaid
MOP00679391OtherRR MEDICARE
MOMA1327030Medicare PIN
MO2006019876OtherSTATE MEDICAL LICENSE