Holly Michelle Ahern, PA-C
Individual provider Active NPI Physician Assistant · Ogden, UT
NPI 1669713079 · NPPES record last updated Oct 17, 2018
Key facts
- NPI
- 1669713079
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 8539843-1206 (UT)
- Practice address
- 5896 S Ridgeline Dr
Ste B
Ogden, UT 84405-6779 - Phone
- (801) 866-0170
- Fax
- (801) 866-0169
- NPI assigned
- Mar 10, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140411001096 | UT | Practitioner - Physician Assistant | 1355573064 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kindly LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 8539843-1206 | UT | Yes |
Addresses
Primary practice location
5896 S Ridgeline Dr
Ste B
Ogden, UT 84405-6779
Mailing address
1055 N 500 W
Attn: Credentialing
Provo, UT 84604-3305
Phone (801) 354-8225
Other providers in Ogden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.