Brookley Valentine Holter, PAC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA00818 Issued in OR

Practice address

3101 SW Sam Jackson Park Rd
Shriner'S Hospital for Children
Portland, OR 97239

Phone

(503) 221-3428

Fax

(503) 221-3490

NPI assigned

Nov 10, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Stephen L Brenneke, M.D., P.C.

  • Specialist
  • Portland, OR
  • NPI 1881868099
  NPD (past)

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513209600000",
    "number": "1710968375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8500, LOCKBOX 7642",
            "address_2": "SHRINER'S HOSPITALS FOR CHILDREN PORTLAND",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191787642",
            "telephone_number": "813-281-8115",
            "fax_number": "813-281-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 SW SAM JACKSON PARK RD",
            "address_2": "SHRINER'S HOSPITAL FOR CHILDREN",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97239",
            "telephone_number": "503-221-3428",
            "fax_number": "503-221-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTER",
        "first_name": "BROOKLEY",
        "middle_name": "VALENTINE",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-10",
        "last_updated": "2017-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OR",
            "license": "PA00818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BCBS",
            "identifier": "080727006",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00186774",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR INDUSTRIES",
            "identifier": "0192176",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara E Holt, ARNP
• Susan Holt, MSW, LCSW
• Madeline Bo-Quan Holte, MOT, OTR/L
• Shamar Holte
• Holter Labs
• Laura Holthausen, LMT
• Sara Holthuis, M.D.
• Carson Holton
• Emily June Holton
• Lance T Holton, D.O.

• Surgical Physician Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Surgical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.