Provider Demographics
NPI:1346285533
Name:HOLADAY, LISA M (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:HOLADAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ARKANSAS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1681
Mailing Address - Country:US
Mailing Address - Phone:870-330-9158
Mailing Address - Fax:870-779-1187
Practice Address - Street 1:1600 ARKANSAS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1681
Practice Address - Country:US
Practice Address - Phone:870-330-9158
Practice Address - Fax:870-779-1187
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134159001Medicaid
AR5K683Medicare ID - Type Unspecified
AR134159001Medicaid