Basic Information
| Provider Information | |||||||||
| NPI: | 1033427620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLT | ||||||||
| FirstName: | DEMMERICE | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | AS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SEALS | ||||||||
| OtherFirstName: | DEMMERICE | ||||||||
| OtherMiddleName: | RENEE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6350 W A J HWY | ||||||||
| Address2: | DEPARTMENT 100 | ||||||||
| City: | TALBOTT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003553565 | ||||||||
| FaxNumber: | 4237142355 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 HEDRICK DR | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378212902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236235301 | ||||||||
| FaxNumber: | 4236250808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2010 | ||||||||
| LastUpdateDate: | 09/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN175949 | TN | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.