Healthcare Provider Details

I. General information

NPI: 1295543395
Provider Name (Legal Business Name): CHRISTINA MARIE JOSEPH HOLTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FIVE FORK PLAZA CT STE A
SIMPSONVILLE SC
29681-5460
US

IV. Provider business mailing address

349 STIRRUP CT
GREER SC
29651-9034
US

V. Phone/Fax

Practice location:
  • Phone: 864-627-0444
  • Fax:
Mailing address:
  • Phone: 203-460-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: