Provider Demographics
NPI:1285138545
Name:HOLT, LAURA MACEY (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MACEY
Last Name:HOLT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-1961
Mailing Address - Country:US
Mailing Address - Phone:876-661-1170
Mailing Address - Fax:
Practice Address - Street 1:5001 MALONEYVILLE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-9219
Practice Address - Country:US
Practice Address - Phone:865-281-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant