Provider Demographics
NPI:1912139171
Name:HOLT, LINDSAY (FNP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD
Mailing Address - Street 2:SUITE 2635
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3271
Mailing Address - Country:US
Mailing Address - Phone:801-387-3515
Mailing Address - Fax:801-387-3520
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:SUITE 2635
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3271
Practice Address - Country:US
Practice Address - Phone:801-387-3515
Practice Address - Fax:801-387-3520
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3670324405363LF0000X
UT367032-4405363LF0000X
UT367032-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily