Provider Demographics
NPI:1225623903
Name:HOLIDAY, KEITHAN
Entity Type:Individual
Prefix:MR
First Name:KEITHAN
Middle Name:
Last Name:HOLIDAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 S BUCKLEY RD UNIT 9
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5639
Mailing Address - Country:US
Mailing Address - Phone:303-353-9822
Mailing Address - Fax:303-353-9822
Practice Address - Street 1:1710 S BUCKLEY RD UNIT 9
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-5639
Practice Address - Country:US
Practice Address - Phone:303-353-9822
Practice Address - Fax:303-353-2280
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO921047101172A00000X
CO147827174H00000X
CONA00720741376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No172A00000XOther Service ProvidersDriver
No174H00000XOther Service ProvidersHealth Educator