Provider Demographics
NPI:1033625611
Name:HOLMES, JAMMIE
Entity Type:Individual
Prefix:
First Name:JAMMIE
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 E CHARLESTON BLVD
Mailing Address - Street 2:188
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-7900
Mailing Address - Country:US
Mailing Address - Phone:702-587-4221
Mailing Address - Fax:
Practice Address - Street 1:1752 PARK MESA LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-2650
Practice Address - Country:US
Practice Address - Phone:702-587-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health