Healthcare Provider Details

I. General information

NPI: 1578421590
Provider Name (Legal Business Name): CORTNEY HOLMES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 E KIMBALLS LN STE 100
DRAPER UT
84020-5021
US

IV. Provider business mailing address

719 S 80 E
VINEYARD UT
84059-5550
US

V. Phone/Fax

Practice location:
  • Phone: 801-233-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6445907-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: