Individual
KELLY L HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2512 HURST DR., MATTOON, IL 61938-9388
(217) 258-5900
(217) 258-5904
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041-335540
IL
363LF0000X
Family Nurse Practitioner
Primary
209007570
IL
Other
Enumeration date
09/22/2008
Last updated
11/26/2014
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