Healthcare Provider Details

I. General information

NPI: 1336501436
Provider Name (Legal Business Name): KALATO LEHUE HOLTS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CARNEGIE PL STE 113
FAYETTEVILLE GA
30214-7903
US

IV. Provider business mailing address

175 CARNEGIE PL STE 113
FAYETTEVILLE GA
30214-7903
US

V. Phone/Fax

Practice location:
  • Phone: 770-376-6160
  • Fax:
Mailing address:
  • Phone: 770-376-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN151100
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number826153
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN151100
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: