Healthcare Provider Details

I. General information

NPI: 1568168623
Provider Name (Legal Business Name): ELIZABETH AHOLT ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PATIENTS FIRST DR STE 1100
WASHINGTON MO
63090-4700
US

IV. Provider business mailing address

810 MACARTHUR ST
WASHINGTON MO
63090-4513
US

V. Phone/Fax

Practice location:
  • Phone: 636-390-1600
  • Fax:
Mailing address:
  • Phone: 636-432-9228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2022044628
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: