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NPI Code Detail

MEDICARE: MS. BRENDA ANN HOLDER

MEDICARE: MS. BRENDA ANN HOLDER
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
1172V00000XCommunity Health WorkerKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326575259
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRENDA ANN HOLDER
Provider Business Mailing Address
First Line : 1351 NEWTOWN PIKE
Second Line :
City : LEXINGTON
State : KY
Zip : 40511-1275
Country : US
Telephone Number : 859-253-1686
Fax Number :
Provider Business Practice Location Address
First Line : 3479 BUCKHORN DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40515-1114
Country : US
Telephone Number : 859-253-1686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2017
Last Update Date : 05/23/2017

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