Provider Demographics
NPI:1225026354
Name:HOLT, SARA E (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:E
Last Name:HOLT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7888 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7008
Mailing Address - Country:US
Mailing Address - Phone:503-724-4474
Mailing Address - Fax:830-255-5817
Practice Address - Street 1:12265 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6232
Practice Address - Country:US
Practice Address - Phone:503-724-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006724363LX0001X
ORAP09400676N5363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9631524Medicaid
8805431Medicare ID - Type Unspecified
WA9631524Medicaid