Healthcare Provider Details

I. General information

NPI: 1184856684
Provider Name (Legal Business Name): ROBIN D HOLT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7107 W 12TH ST SUITE 201
LITTLE ROCK AR
72204-2404
US

IV. Provider business mailing address

7107 W 12TH ST SUITE 201
LITTLE ROCK AR
72204-2404
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-1837
  • Fax: 501-663-1839
Mailing address:
  • Phone: 501-663-1837
  • Fax: 501-663-1839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR78659
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: