Provider Demographics
NPI:1730073297
Name:BOOKHOLT, MIKKI (FNP)
Entity type:Individual
Prefix:
First Name:MIKKI
Middle Name:
Last Name:BOOKHOLT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MIKKI
Other - Middle Name:
Other - Last Name:SEBASTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 NEWMAN SPRINGS RD E
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 STATE ROUTE 10
Practice Address - Street 2:
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852-9667
Practice Address - Country:US
Practice Address - Phone:973-584-6751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15378800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily