Provider Demographics
NPI:1609203363
Name:KOLDYKE, BRIAN BENNETT (MSN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:BENNETT
Last Name:KOLDYKE
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2097
Mailing Address - Country:US
Mailing Address - Phone:435-688-6262
Mailing Address - Fax:435-688-6263
Practice Address - Street 1:577 S RIVER RD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2097
Practice Address - Country:US
Practice Address - Phone:435-688-6262
Practice Address - Fax:435-688-6263
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5850890-4405363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily