Provider Demographics
NPI:1093511248
Name:HOLMES, KIZZETTA JO-VAN (MA)
Entity type:Individual
Prefix:
First Name:KIZZETTA
Middle Name:JO-VAN
Last Name:HOLMES
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 OHIO ST APT 8
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6142
Mailing Address - Country:US
Mailing Address - Phone:402-212-2866
Mailing Address - Fax:
Practice Address - Street 1:9208 OHIO ST APT 8
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6142
Practice Address - Country:US
Practice Address - Phone:402-212-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant