MEDICARE: HEATHER JASMINE HOLTON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	102705	WV
2	363LA2100X	Acute Care Nurse Practitioner	4047875	KY
3	363LA2100X	Acute Care Nurse Practitioner	APRN.NP.0041205	OH

General Provider Information

NPI Number	:	1063076388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER JASMINE HOLTON APRN

Provider Business Mailing Address
First Line	:	2201 LEXINGTON AVE
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-2843
Country	:	US
Telephone Number	:	606-408-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 23RD ST STE 510
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-2878
Country	:	US
Telephone Number	:	606-329-9335
Fax Number	:	606-324-6383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	05/26/2026

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