Basic Information
| Provider Information | |||||||||
| NPI: | 1437178191 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLT | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7710 BUTTE AVE | ||||||||
| Address2: | |||||||||
| City: | SUTTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959822159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306749061 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4062 FLYING C RD STE 41 | ||||||||
| Address2: | |||||||||
| City: | CAMERON PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956829664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306768234 | ||||||||
| FaxNumber: | 5306760819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 438668 | CA | X | Nursing Service Providers | Registered Nurse | 363LF0000X | FNP13130 | CA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 11442452 | 01 | CA | CAQH | OTHER | 438668 | 01 | CA | CA RN LICENSE | OTHER | FNP13130 | 01 | CA | LICENSE | OTHER | 7246642 | 01 | CA | AETNA | OTHER | RN438668 | 05 | CA | MEDICAID |