Provider Demographics
NPI:1316650054
Name:HOLT, KENDALL MALIK
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:MALIK
Last Name:HOLT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 COOLEY LN
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3280
Mailing Address - Country:US
Mailing Address - Phone:937-397-4058
Mailing Address - Fax:
Practice Address - Street 1:2292 COOLEY LN
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3280
Practice Address - Country:US
Practice Address - Phone:937-397-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUT750296374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide