Provider Demographics
NPI:1306997747
Name:HOLMES, AMELIA (NP)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:181 N KENTUCKY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2089
Mailing Address - Country:US
Mailing Address - Phone:417-257-5911
Mailing Address - Fax:417-257-5913
Practice Address - Street 1:181 N KENTUCKY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2089
Practice Address - Country:US
Practice Address - Phone:417-257-5911
Practice Address - Fax:417-257-5913
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2018-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO131292363L00000X
CA95004233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
R22216Medicare UPIN