NPIMap

Ken V Holt, D.O.

Individual provider Active NPI Obstetrics & Gynecology Physician · Lander, WY

NPI 1104894047 · NPPES record last updated May 17, 2023

Key facts

NPI
1104894047
Entity type
Individual (NPI type 1)
Primary specialty
Obstetrics & Gynecology Physician 207V00000X
License
13534A (WY)
Practice address
125 Wyoming St
Lander, WY 82520-3919
Phone
(307) 206-1330
Fax
(307) 206-1331
NPI assigned
Mar 8, 2006
Sex
Male
Sole proprietor
Yes

Organizations & group practices 27

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 27

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Medicare Care Compare profile

Specialty
Obstetrics/Gynecology
Also: Family Practice
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital of Sweetwater County (70 clinicians)
Lake Regional Health System (132 clinicians)

Practice addresses (Care Compare)

1180 College Dr
Rock Springs, WY 82901-5863
Phone (307) 352-8125

54 Hospital Dr
Osage Beach, MO 65065-3050

Hospital & facility affiliations

  • Memorial Hospital Sweetwater County Hospital · Rock Springs, WY · CCN 531318
  • Lake Regional Health System Hospital · Osage Beach, MO · CCN 260186

Medicare participation

Medicare fee-for-service enrollment
Enrolled (4 enrollments) in MO, WY, AR, AK
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20050810001135 MO Practitioner - Obstetrics/Gynecology
Practitioner - Osteopathic Manipulative Medicine		 1557390424 Reassigns benefits to 2 organizations
I20210506001563 WY Practitioner - Obstetrics/Gynecology
Practitioner - Family Practice		 1557390424 Reassigns benefits to 3 organizations
I20231005002407 AR Practitioner - Obstetrics/Gynecology 1557390424 Reassigns benefits to 1 organization
I20250909003516 AK Practitioner - Obstetrics/Gynecology 1557390424 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
No
HHS exclusion list flag
The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Baxter County Regional Hospital, Inc Current
since Sep 5, 2023		 Accepting new patients
Golden Valley Memorial Hospital District Current
since Aug 1, 2005		 Accepting new patients
Golden Valley Memorial Hospital District Current
since Aug 1, 2005		 Accepting new patients
Golden Valley Memorial Hospital District Current Accepting new patients
Memorial Hospital of Sweetwater County Current
since Sep 23, 2022		 Accepting new patients
Mat-Su Valley III LLC Obstetrics & Gynecology Current
since Jul 1, 2025		 Accepting new patients
Baxter County Regional Hospital Inc Current Accepting new patients
Baxter County Regional Hospital Inc Current
since Sep 5, 2023		 Accepting new patients
Mat-Su Valley III LLC Current
since Jul 1, 2025		 Accepting new patients
Memorial Hospital of Sweetwater County Past Accepting new patients
Lake Regional Health System Past Accepting new patients

Locations

950 E Bogard Rd
Ste 207
Wasilla, AK 99654
Phone (907) 357-9444

505 Hospital Dr
Ste 1
Mountain Home, AR 72653
Phone (870) 508-3260

628 Hospital Dr
Ste E
Mountain Home, AR 72653
Phone (870) 424-4710

10 Medical Plz
Mountain Home, AR 72653
Phone (870) 424-3824

1602 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

1600 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

1200 College Dr
Rock Springs, WY 82901
Phone (307) 352-8352

1180 College Dr
Rock Springs, WY 82901
Phone (307) 352-8125

Interoperability endpoints

  • Direct secure messaging: ken.holt@bhcawp.eclinicaldirectplus.com

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 2005020340 MO
Obstetrics & Gynecology Physician 207V00000X 13534A WY Yes

Addresses

Primary practice location

125 Wyoming St
Lander, WY 82520-3919

Mailing address

125 Wyoming St
Lander, WY 82520-3919
Phone (307) 206-1330

Other names

  • Dr. Kenny V Holt Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 17, 2023.

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1104894047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 WYOMING ST",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203919",
            "telephone_number": "307-206-1330",
            "fax_number": "307-206-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 WYOMING ST",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203919",
            "telephone_number": "307-206-1330",
            "fax_number": "307-206-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLT",
        "first_name": "KEN",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MO",
            "license": "2005020340",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WY",
            "license": "13534A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNY",
            "last_name": "HOLT",
            "middle_name": "V",
            "prefix": "DR.",
            "credential": "DO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lander, WY

All providers in Lander, WY · Obstetrics & Gynecology Physician in Wyoming

Sources for this page

Verify at the official NPI Registry.