Healthcare Provider Details

I. General information

NPI: 1316533698
Provider Name (Legal Business Name): KODY KEITH HOLT FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S. 200 E
ENTERPRISE UT
84725
US

IV. Provider business mailing address

PO BOX 758
ENTERPRISE UT
84725-0758
US

V. Phone/Fax

Practice location:
  • Phone: 435-878-2281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9809369-4408
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: