Provider Demographics
NPI:1437178191
Name:HOLT, JAMES M (FNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:HOLT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 BUTTE AVE
Mailing Address - Street 2:
Mailing Address - City:SUTTER
Mailing Address - State:CA
Mailing Address - Zip Code:95982-2159
Mailing Address - Country:US
Mailing Address - Phone:530-674-9061
Mailing Address - Fax:
Practice Address - Street 1:4062 FLYING C RD STE 41
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-9664
Practice Address - Country:US
Practice Address - Phone:530-676-8234
Practice Address - Fax:530-676-0819
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438668163W00000X
CAFNP13130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11442452OtherCAQH
CA438668OtherCA RN LICENSE
CAFNP13130OtherLICENSE
CA7246642OtherAETNA
CARN438668Medicaid