Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 37416 | KY |
N | 207VX0000X | Obstetrician | 37416 | KY |
NPI | 1033153085 |
---|---|
Provider Name | Shannon L Holt |
First Address | Elizabethtown, KY 42701-2749 |
Second Address | Elizabethtown, KY 42701-2749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 09/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64085442 | (05) | KY |
I15357 | (02) |