Provider Demographics
NPI:1669828885
Name:HOLT, KRYSTLE THOMAS (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:THOMAS
Last Name:HOLT
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:BROOKE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:745 HOLLY HILLS RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-6964
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:594 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:CULLOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723-1589
Practice Address - Country:US
Practice Address - Phone:828-330-9903
Practice Address - Fax:833-492-5875
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86039659133V00000X
NCL004714133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ53785D811Medicare PIN