Provider Demographics
NPI:1124566104
Name:HOLMES, LEANNE MICHELLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:MICHELLE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2387
Mailing Address - Country:US
Mailing Address - Phone:573-843-8380
Mailing Address - Fax:573-843-8381
Practice Address - Street 1:2651 SHELBY RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2387
Practice Address - Country:US
Practice Address - Phone:573-843-8380
Practice Address - Fax:573-843-8381
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017003066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily