Healthcare Provider Details

I. General information

NPI: 1871511998
Provider Name (Legal Business Name): BRIDGETTE HOLT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63110-1016
US

IV. Provider business mailing address

510 S KINGSHIGHWAY BLVD C B 8131
SAINT LOUIS MO
63110-1016
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7111
  • Fax: 314-362-4189
Mailing address:
  • Phone: 314-362-7111
  • Fax: 314-362-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200163407
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: