1437178191 NPI number — JAMES M HOLT F.N.P.

Table of content: JAMES M HOLT F.N.P. (NPI 1437178191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437178191 NPI number — JAMES M HOLT F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLT
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
F.N.P.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437178191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7710 BUTTE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUTTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95982-2159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-674-9061
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4062 FLYING C RD STE 41
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMERON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95682-9664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-676-8234
Provider Business Practice Location Address Fax Number:
530-676-0819
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  438668 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LF0000X , with the licence number: FNP13130 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11442452 . This is a "CAQH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 438668 . This is a "CA RN LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FNP13130 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7246642 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: RN438668 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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