Healthcare Provider Details

I. General information

NPI: 1265059133
Provider Name (Legal Business Name): CORY LEWIS HOLT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W MORRIS BLVD STE 400B
MORRISTOWN TN
37813-2282
US

IV. Provider business mailing address

735 HARVEY DR
RUSSELLVILLE TN
37860-8904
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-5925
  • Fax:
Mailing address:
  • Phone: 423-736-7097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number27748
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: