Anjae Taray Holder

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

1174771 Issued in TX

Practice address

1759 Broad Park Cir S Ste 201
Mansfield, TX 76063-7834

Phone

(682) 341-3910

NPI assigned

Dec 6, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kidsville Pediatrics PLLC

  • Pediatric Critical Care Medicine Physician
  • Mansfield, TX
  • NPI 1689264996

  Pediatrics

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1831905694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MIRAMAR AVE",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751154816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1759 BROAD PARK CIR S STE 201",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760637834",
            "telephone_number": "682-341-3910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDER",
        "first_name": "ANJAE",
        "middle_name": "TARAY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-06",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "1174771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeannine Koay Hoang, M.D.
• Lisabeth D Hogan-Moody, PA-C
• Angel Holbert
• Kirstie H Holbrook, M.ED., LPC
• Regenia K Holden, LCDC
• Holistic Approach to Mental Health, LLC
• Jeanette Rene Holland, LCSW
• Steven Holland, SLP-ASSISTANT
• Kailey Holmes
• Homage Healthcare Services, Inc

• Pediatric Nurse Practitioner in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Pediatric Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.