Provider Demographics
NPI:1316330228
Name:HOLMES, MELISSA GAYLE (FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAYLE
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 1:4415 STATE ROUTE 350
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45146-3306
Mailing Address - Country:US
Mailing Address - Phone:937-218-6714
Mailing Address - Fax:
Practice Address - Street 1:2845 PROGRESS WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177
Practice Address - Country:US
Practice Address - Phone:937-366-1082
Practice Address - Fax:937-366-1083
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.221712-COA1363LF0000X
OHAPRN.CNP.16956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily