Provider Demographics
NPI:1952638587
Name:HOLT, MISTY MICHELLE (RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:MICHELLE
Last Name:HOLT
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:TX
Mailing Address - Zip Code:79257-2565
Mailing Address - Country:US
Mailing Address - Phone:806-823-2449
Mailing Address - Fax:806-823-2453
Practice Address - Street 1:701 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:TX
Practice Address - Zip Code:79257-2565
Practice Address - Country:US
Practice Address - Phone:806-823-2449
Practice Address - Fax:806-823-2453
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX733852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily