Healthcare Provider Details

I. General information

NPI: 1902468275
Provider Name (Legal Business Name): KATLYN HOLT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HARLEM RD
WEST SENECA NY
14224-1151
US

IV. Provider business mailing address

69 FERNDALE AVE
BUFFALO NY
14217-1003
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-8400
  • Fax: 716-631-8408
Mailing address:
  • Phone: 716-909-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: