Provider Demographics
NPI:1598469173
Name:HOLT, KEISHALEI (RN)
Entity Type:Individual
Prefix:
First Name:KEISHALEI
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 E 1850 N UNIT 40
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-3099
Mailing Address - Country:US
Mailing Address - Phone:435-919-6556
Mailing Address - Fax:
Practice Address - Street 1:2830 S REDWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-5626
Practice Address - Country:US
Practice Address - Phone:385-303-4592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11822477-3102163WC1500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health