Healthcare Provider Details

I. General information

NPI: 1457989238
Provider Name (Legal Business Name): JONATHAN LYLE HOLT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 HILLCREST DR STE 1
WACO TX
76708-3144
US

IV. Provider business mailing address

101 W LOUIS HENNA BLVD STE 300
AUSTIN TX
78728-1203
US

V. Phone/Fax

Practice location:
  • Phone: 254-741-6641
  • Fax: 254-537-4693
Mailing address:
  • Phone: 512-244-4272
  • Fax: 512-593-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25674
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberV8284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: