MEDICARE: MRS. HOLLY B HOLT C.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	01588	OH

General Provider Information

NPI Number	:	1053478883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY B HOLT C.N.P.

Provider Business Mailing Address
First Line	:	6100 E MAIN ST
Second Line	:	SUITE 112
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3399
Country	:	US
Telephone Number	:	614-759-6200
Fax Number	:	614-759-6443

Provider Business Practice Location Address
First Line	:	6100 E MAIN ST
Second Line	:	SUITE 112
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3399
Country	:	US
Telephone Number	:	614-759-6200
Fax Number	:	614-759-6443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	04/18/2013

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