Healthcare Provider Details

I. General information

NPI: 1841079449
Provider Name (Legal Business Name): JENNA HOLT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CHURCH AVE SW
ROANOKE VA
24011-1906
US

IV. Provider business mailing address

312 FAIRY STREET EXT STE 101
MARTINSVILLE VA
24112-1912
US

V. Phone/Fax

Practice location:
  • Phone: 540-769-3964
  • Fax: 276-629-4271
Mailing address:
  • Phone: 276-201-1647
  • Fax: 276-226-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024188028
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: