Provider Demographics
NPI:1982397436
Name:HOLIFIELD, PRESTON THOMAS (FNP-C)
Entity type:Individual
Prefix:MR
First Name:PRESTON
Middle Name:THOMAS
Last Name:HOLIFIELD
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 MYRA DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5803
Mailing Address - Country:US
Mailing Address - Phone:573-200-6143
Mailing Address - Fax:573-755-0706
Practice Address - Street 1:2441 MYRA DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5803
Practice Address - Country:US
Practice Address - Phone:573-200-6143
Practice Address - Fax:573-755-0706
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023019957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily