Provider Demographics
NPI:1770247074
Name:HOLTSCLAW, CHARITY J
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:J
Last Name:HOLTSCLAW
Suffix:
Gender:
Credentials:
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 38
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0038
Mailing Address - Country:US
Mailing Address - Phone:812-738-4251
Mailing Address - Fax:812-738-7833
Practice Address - Street 1:1263 HOSPITAL DR NW STE 250
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2176
Practice Address - Country:US
Practice Address - Phone:812-738-4915
Practice Address - Fax:812-738-7833
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011756A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily