Provider Demographics
NPI:1588395867
Name:HOLTON, RACHEL (PERSONAL CARE ASSIST)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:HOLTON
Suffix:
Gender:F
Credentials:PERSONAL CARE ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 HORSESHOE RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT GROVE
Mailing Address - State:MS
Mailing Address - Zip Code:39189-6021
Mailing Address - Country:US
Mailing Address - Phone:601-253-6336
Mailing Address - Fax:
Practice Address - Street 1:210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-2613
Practice Address - Country:US
Practice Address - Phone:601-357-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07680072Medicaid