Provider Demographics
NPI:1043977887
Name:HOLMES, ANESHA L (APRN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:ANESHA
Middle Name:L
Last Name:HOLMES
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 FISH HATCHERY RD UNIT F4
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172-2685
Mailing Address - Country:US
Mailing Address - Phone:803-404-7421
Mailing Address - Fax:803-898-2194
Practice Address - Street 1:2490 FISH HATCHERY RD UNIT F4
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29172-2685
Practice Address - Country:US
Practice Address - Phone:803-404-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty