Provider Demographics
NPI:1063973832
Name:CARTER, HOLLY LEE (APRN, FNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LEE
Last Name:CARTER
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W 800 S
Mailing Address - Street 2:
Mailing Address - City:GENOLA
Mailing Address - State:UT
Mailing Address - Zip Code:84655-6015
Mailing Address - Country:US
Mailing Address - Phone:385-236-4234
Mailing Address - Fax:801-396-6999
Practice Address - Street 1:545 W 800 S
Practice Address - Street 2:
Practice Address - City:GENOLA
Practice Address - State:UT
Practice Address - Zip Code:84655-6015
Practice Address - Country:US
Practice Address - Phone:385-236-4234
Practice Address - Fax:801-396-6999
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344698-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily