Healthcare Provider Details

I. General information

NPI: 1316863053
Provider Name (Legal Business Name): AVI HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 S 400 E
OGDEN UT
84405-7194
US

IV. Provider business mailing address

1136 TEE TIME DR
FARMINGTON UT
84025-2919
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-1777
  • Fax:
Mailing address:
  • Phone: 801-920-7224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11501190-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: