Provider Demographics
NPI:1114684990
Name:HOLMES, LATESHA (CPT)
Entity Type:Individual
Prefix:
First Name:LATESHA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 CAMP BOWIE BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3800
Mailing Address - Country:US
Mailing Address - Phone:337-274-3937
Mailing Address - Fax:
Practice Address - Street 1:7516 NOBLE OAK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120
Practice Address - Country:US
Practice Address - Phone:337-274-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy