Provider Demographics
NPI:1265059133
Name:HOLT, CORY LEWIS (NP)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:LEWIS
Last Name:HOLT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 HARVEY DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37860-8904
Mailing Address - Country:US
Mailing Address - Phone:423-736-7097
Mailing Address - Fax:
Practice Address - Street 1:420 W MORRIS BLVD STE 400B
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2282
Practice Address - Country:US
Practice Address - Phone:423-581-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27748363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner