Provider Demographics
NPI:1629034293
Name:HOLT, REBECCA BARKSDALE (PAC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:BARKSDALE
Last Name:HOLT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 41008
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-1008
Mailing Address - Country:US
Mailing Address - Phone:800-849-5609
Mailing Address - Fax:910-483-8921
Practice Address - Street 1:4100 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6227
Practice Address - Country:US
Practice Address - Phone:919-872-3959
Practice Address - Fax:919-872-6066
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2008-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC104140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1629034293OtherNPI