Provider Demographics
NPI:1518488071
Name:HOLT, CARRIE LYNNE (DNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNNE
Last Name:HOLT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:L
Other - Last Name:KINCADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:226 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SABIN
Mailing Address - State:MN
Mailing Address - Zip Code:56580-4152
Mailing Address - Country:US
Mailing Address - Phone:218-371-5873
Mailing Address - Fax:
Practice Address - Street 1:1412 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:MN
Practice Address - Zip Code:56549
Practice Address - Country:US
Practice Address - Phone:218-483-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily