NPIMap

Individual provider Active NPI

Mitchell Holmes, DNP, AGNP-C

  • Nurse Practitioner
  • Taylorsville, UT
National Provider Identifier
1710721261
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
14020856-8900 Issued in UT
Practice address
4464 S Driftwood Dr
Taylorsville, UT 84123-3208
Phone
(801) 360-1063
NPI assigned
Jun 20, 2024
Last updated
Jun 20, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 14020856-8900 UT Primary

Addresses

Primary practice location

4464 S Driftwood Dr
Taylorsville, UT 84123-3208

Mailing address

4464 S Driftwood Dr
Taylorsville, UT 84123-3208
Phone (801) 360-1063

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240806000325 UT Practitioner - Nurse Practitioner 0749727998 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Amazing Medical Associates IncGroup PAC ID 5991606329, 24 clinicians

Practice addresses (Care Compare)

434 W Ascension Way
Suite 225
Murray, UT 84123-2985
Phone (801) 716-7008

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
14020856-8900UTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Amazing Medical Associates, Inc CurrentSince May 23, 2024 Accepting new patients

Locations

434 W Ascension Way
Ste 225
Salt Lake City, UT 84123
Phone (801) 716-7008

Organizations & group practices 1

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

Hospital & facility affiliations 11

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1710721261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4464 S DRIFTWOOD DR",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841233208",
            "telephone_number": "801-360-1063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4464 S DRIFTWOOD DR",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841233208",
            "telephone_number": "801-360-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "MITCHELL",
        "credential": "DNP, AGNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "14020856-8900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylorsville, UT

Sources for this page

Verify at the official NPI Registry.