Provider Demographics
NPI:1568838878
Name:HOLT, LADONNA M
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:M
Last Name:HOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LADONNA
Other - Middle Name:M
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:189 N CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5357
Mailing Address - Country:US
Mailing Address - Phone:559-797-6682
Mailing Address - Fax:
Practice Address - Street 1:125 E BARSTOW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5020
Practice Address - Country:US
Practice Address - Phone:559-486-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA745946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily