Provider Demographics
NPI:1073883369
Name:HOLMES, Y'VONDA DARLENE (APRN, FNP, CNP)
Entity Type:Individual
Prefix:MS
First Name:Y'VONDA
Middle Name:DARLENE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:APRN, FNP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:1605 MARTIN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2982
Practice Address - Country:US
Practice Address - Phone:573-458-6326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011026455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431560263OtherTRICARE
MO080020472OtherRR MCR
MO1073883369Medicaid
MO1073883369Medicaid