Provider Demographics
NPI:1902468275
Name:HOLT, KATLYN (PA)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1546 TOWERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2932
Mailing Address - Country:US
Mailing Address - Phone:716-909-5348
Mailing Address - Fax:
Practice Address - Street 1:705 MAPLE RD STE 300
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3291
Practice Address - Country:US
Practice Address - Phone:716-631-8400
Practice Address - Fax:716-631-8408
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant