Provider Demographics
NPI:1972800712
Name:HOLDER, CHRISTY HALLIE (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:HALLIE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W DIXIE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1704
Mailing Address - Country:US
Mailing Address - Phone:270-307-1980
Mailing Address - Fax:270-900-0055
Practice Address - Street 1:300 W DIXIE AVE STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1704
Practice Address - Country:US
Practice Address - Phone:270-307-1980
Practice Address - Fax:270-900-0055
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1105950163W00000X
KY3006696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100169600Medicaid
KY50109995OtherPASSPORT
KYK015293Medicare PIN
KYK015291Medicare PIN