Provider Demographics
NPI:1992184485
Name:HOLSEY, MARK DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DANIEL
Last Name:HOLSEY
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 1:2400 N STALLINGS DR STE 13
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-1222
Mailing Address - Country:US
Mailing Address - Phone:936-205-1724
Mailing Address - Fax:
Practice Address - Street 1:2400 N STALLINGS DR STE 13
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-1222
Practice Address - Country:US
Practice Address - Phone:936-205-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3902000002084P0800X
OK1992184485208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry