Healthcare Provider Details

I. General information

NPI: 1275276354
Provider Name (Legal Business Name): NATHANIEL MICHAEL HOLTE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CROWN DR
KIRKSVILLE MO
63501-2570
US

IV. Provider business mailing address

PO BOX 1239
HANNIBAL MO
63401-1239
US

V. Phone/Fax

Practice location:
  • Phone: 660-665-9000
  • Fax: 660-665-8445
Mailing address:
  • Phone: 573-406-1300
  • Fax: 573-248-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number113699
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number2025026923
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2025026923
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: