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General NPI Number Information
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NPI Number | 1184958787
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Entity Type | Individual
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Provider Name | HEATHER LEIGH HOLT PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 807 W CRAFT ST
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City | ROBINSON
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State | IL
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Zip | 62454-1137
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Country | US
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Telephone | 618-546-5052
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Fax | 618-544-2094
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Provider Business Mailing Address
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Address Line | 807 W CRAFT ST
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City | ROBINSON
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State | IL
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Zip | 62454-1137
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Country | US
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Telephone | 618-546-5052
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Fax | 618-544-2094
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085003564
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License Number State | IL
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