Individual provider Active NPI

Kalato Lehue Holts, FNP

  • Nurse Practitioner
  • Fayetteville, GA
National Provider Identifier
1336501436
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN151100 Issued in GA
Practice address
175 Carnegie PL Ste 113
Fayetteville, GA 30214-7903
Phone
(770) 376-6160
NPI assigned
Mar 28, 2016
Last updated
Sep 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN151100 GA
Nurse Practitioner 363L00000X RN151100 GA Primary
Nurse Practitioner 363L00000X 826153 NV

Addresses

Primary practice location

175 Carnegie PL Ste 113
Fayetteville, GA 30214-7903

Mailing address

175 Carnegie PL Ste 113
Fayetteville, GA 30214-7903
Phone (770) 376-6160

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, OR, CA, NY4 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20160804001845 GA Practitioner - Nurse Practitioner 3779876354 Reassigns benefits to 2 organizations
I20250926004425 OR Practitioner - Nurse Practitioner 3779876354
I20251006003169 CA Practitioner - Nurse Practitioner 3779876354
I20260623001721 NY Practitioner - Nurse Practitioner 3779876354 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5102 21St St
Suite 111
Long Island City, NY 11101-5357
Phone (888) 391-4999

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN151100GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Procare Network Nurse Practitioner CurrentSince Apr 30, 2024 Accepting new patients
Chronic Disease Management of Georgia, LLC CurrentSince Dec 1, 2024 Accepting new patients
Holts Healthcare PC Nurse Practitioner PastSince Mar 28, 2021 Accepting new patients

Locations

3701 Santa Rosalia Dr
Los Angeles, CA 90008
Phone (323) 538-2273

175 Carnegie Pl
Ste 113
Fayetteville, GA 30214
Phone (470) 402-9409

704 Breedlove Dr
#A
Monroe, GA 30655
Phone (888) 772-0076

5102 21st St
#111
Long Island City, NY 11101

1631 NE Broadway St
Portland, OR 97232
Phone (888) 391-4999

Interoperability endpoints

  • Direct secure messaging: kalato.holts.p1@direct.rrhc.nextgenshare.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1336501436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 CARNEGIE PL STE 113",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147903",
            "telephone_number": "770-376-6160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 CARNEGIE PL STE 113",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147903",
            "telephone_number": "770-376-6160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTS",
        "first_name": "KALATO",
        "middle_name": "LEHUE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-28",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN151100",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN151100",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NV",
            "license": "826153",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

Verify at the official NPI Registry.