MEDICARE: KEALOHA SARAH REIKO SNOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2064952	UT
2	363LF0000X	Family Nurse Practitioner	5916938-4405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5916938-8900	OTHER	UT	APRN CONTROLLED SUBSTANCE
2	5916938-4405	OTHER	UT	APRN

General Provider Information

NPI Number	:	1851175186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEALOHA SARAH REIKO SNOW

Provider Business Mailing Address
First Line	:	1485 W 1930 N
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-9403
Country	:	US
Telephone Number	:	808-561-3254
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 W 1930 N
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-9403
Country	:	US
Telephone Number	:	808-561-3254
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	05/13/2026

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