Healthcare Provider Details

I. General information

NPI: 1215291265
Provider Name (Legal Business Name): DAVID ROBB HOLTON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 LEWISVILLE CLEMMONS RD
LEWISVILLE NC
27023-8251
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-712-0700
  • Fax: 336-712-0876
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5005684
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5005684
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: