Provider Demographics
NPI:1588160576
Name:HOLSTEAD, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HOLSTEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CORPORATE HILL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4537
Mailing Address - Country:US
Mailing Address - Phone:501-227-6727
Mailing Address - Fax:501-223-9462
Practice Address - Street 1:27 CORPORATE HILL DR STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4537
Practice Address - Country:US
Practice Address - Phone:501-227-6727
Practice Address - Fax:501-223-9462
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE14288208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty