Provider Demographics
NPI:1760481535
Name:HOLDEN, CAROL D (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:D
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:STE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6533
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245208367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85691UOtherBLUE CROSS BLUE SHIELD
TX8683UGOtherBCBS TX
TX002819301Medicaid
TX002819303Medicaid
TX002819302Medicaid
TX002819304Medicaid
TX8683UAOtherBCBS
TXP00957435OtherRAILROAD
TX8683UAOtherBCBS
TX002819301Medicaid
TX002819303Medicaid
TX82925HMedicare PIN
TXTXB114278Medicare PIN
TX002819304Medicaid