Healthcare Provider Details

I. General information

NPI: 1710777933
Provider Name (Legal Business Name): KERSTIN TAYLOR HOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 PERRY PKWY STE C
PERRY GA
31069-8428
US

IV. Provider business mailing address

277 PERRY PKWY STE C
PERRY GA
31069-8428
US

V. Phone/Fax

Practice location:
  • Phone: 478-988-6087
  • Fax: 478-988-6092
Mailing address:
  • Phone: 478-988-6087
  • Fax: 478-988-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP300175
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: