Provider Demographics
NPI:1144450727
Name:HOLT, LORI JANE (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JANE
Last Name:HOLT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 TAZEWELL PIKE
Mailing Address - Street 2:SUITE G
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1880
Mailing Address - Country:US
Mailing Address - Phone:865-689-4421
Mailing Address - Fax:865-689-4443
Practice Address - Street 1:2900 TAZEWELL PIKE
Practice Address - Street 2:SUITE G
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1880
Practice Address - Country:US
Practice Address - Phone:865-689-4421
Practice Address - Fax:865-689-4443
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN145997163W00000X
NC5005177363LP0808X
TN14378363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004915Medicaid
NC7004915Medicaid