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General NPI Number Information
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NPI Number | 1174151229
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Entity Type | Individual
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Provider Name | KATHRYN HOLT
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Gender | Female
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 227 NW 3RD AVE
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City | CANBY
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State | OR
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Zip | 97013-3640
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Country | US
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Telephone | 503-416-4547
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Fax |
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Provider Business Mailing Address
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Address Line | 7320 SW HUNZIKER RD STE 300
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City | TIGARD
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State | OR
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Zip | 97223-2302
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Country | US
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Telephone | 503-941-3077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD210240
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License Number State | OR
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