Provider Demographics
NPI:1932624343
Name:HOLT, AMY ALICIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ALICIA
Last Name:HOLT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:ALICIA
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2291 CORNERSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-5121
Mailing Address - Country:US
Mailing Address - Phone:931-288-8031
Mailing Address - Fax:
Practice Address - Street 1:2291 CORNERSVILLE HWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-5121
Practice Address - Country:US
Practice Address - Phone:931-288-8031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000206620163W00000X
TN35504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse