Provider Demographics
NPI:1285159970
Name:HOLMES, ASHLEIGH MARIA (RN, MSN, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:MARIA
Last Name:HOLMES
Suffix:
Gender:F
Credentials:RN, MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HARBORSIDE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1020
Mailing Address - Country:US
Mailing Address - Phone:518-881-4700
Mailing Address - Fax:518-881-4719
Practice Address - Street 1:200 HARBORSIDE DR STE 101
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1020
Practice Address - Country:US
Practice Address - Phone:518-881-4700
Practice Address - Fax:518-881-4719
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY734003163W00000X
NY308489363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04955111Medicaid