Provider Demographics
NPI:1407991086
Name:HOLMES, ROCKY (FNP)
Entity type:Individual
Prefix:
First Name:ROCKY
Middle Name:
Last Name:HOLMES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3856 HWY 57 WEST
Mailing Address - Street 2:PO BOX 99
Mailing Address - City:RAMER
Mailing Address - State:TN
Mailing Address - Zip Code:38367
Mailing Address - Country:US
Mailing Address - Phone:731-645-6118
Mailing Address - Fax:731-645-8312
Practice Address - Street 1:232 MARKET ST
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3339
Practice Address - Country:US
Practice Address - Phone:337-991-9276
Practice Address - Fax:337-943-0846
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN8335363LF0000X
MSR685993363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN8335OtherMEDICAL LICENSE
TNS571808Medicare UPIN