Individual
HEATHER LEIGH HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
807 W CRAFT ST, ROBINSON, IL 62454-1137
(618) 546-5052
(618) 544-2094
Mailing address
807 W CRAFT ST, ROBINSON, IL 62454-1137
(618) 546-5052
(618) 544-2094
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003564
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085.003564
PHYSICIAN ASSISTANT LICENSE
IL
01
—
1088888
NCCPA CERTIFICATION
IL
Enumeration date
09/29/2009
Last updated
06/16/2015
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