Healthcare Provider Details

I. General information

NPI: 1457181158
Provider Name (Legal Business Name): KATHRYN HOLMES DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 S STATE ST STE 101
DRAPER UT
84020-9405
US

IV. Provider business mailing address

12101 S STATE ST STE 101
DRAPER UT
84020-9405
US

V. Phone/Fax

Practice location:
  • Phone: 801-501-9797
  • Fax:
Mailing address:
  • Phone: 801-501-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9804426-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: