Kenyatta Ja'Cobe Holt

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LPN.184609.MEDS-IV Issued in OH

Practice address

732 Beckman St
Dayton, OH 45410-2165

Phone

(937) 253-1680

NPI assigned

Feb 6, 2024

Last updated

Feb 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Nova Behavioral Health, Inc

  • Substance Abuse Rehabilitation Facility
  • Dayton, OH
  • NPI 1548217748
  NPD
• Nova Behavioral Health, Inc.

  • Substance Abuse Rehabilitation Facility
  • Dayton, OH
  • NPI 1164782017
  NPD (past)

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

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1881457307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4579 BUFORT BLVD APT B",
            "city": "HUBER HEIGHTS",
            "state": "OH",
            "postal_code": "454248502",
            "telephone_number": "937-305-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 BECKMAN ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454102165",
            "telephone_number": "937-253-1680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLT",
        "first_name": "KENYATTA",
        "middle_name": "JA'COBE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-06",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "LPN.184609.MEDS-IV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trevor G Holsinger, CRNA
• Holt Street Miracle Center
• Derricka Holt
• John E Holt II
• Joshua Holt
• Lois Holt
• Nyisha Holt, LPN
• Ralonda Holt
• Stacey L Holt
• Helen Ruth Holte-Dacosta, DDS

• Licensed Practical Nurse in Dayton, OH
• Providers in Dayton, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.