Provider Demographics
NPI:1699582122
Name:HOLMES, TERESA JUNTILLA (PMHNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:JUNTILLA
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 HAMPTON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-3006
Mailing Address - Country:US
Mailing Address - Phone:508-566-4524
Mailing Address - Fax:
Practice Address - Street 1:3077 N MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1735
Practice Address - Country:US
Practice Address - Phone:910-275-5766
Practice Address - Fax:866-990-0668
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC318175363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health