Provider Demographics
NPI:1467119693
Name:HOLT, JAYME BROOKE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:BROOKE
Last Name:HOLT
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:JAYME
Other - Middle Name:BROOKE
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:740 S LIMESTONE ST L543
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-4739
Mailing Address - Country:US
Mailing Address - Phone:859-285-9358
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-4739
Practice Address - Country:US
Practice Address - Phone:859-323-9057
Practice Address - Fax:859-323-9502
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016532363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner