Provider Demographics
NPI:1124566104
Name:HOLMES, LEANNE MICHELLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:MICHELLE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 10
Mailing Address - Street 2:#1 HAL'S PLAZA DRIVE
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957
Mailing Address - Country:US
Mailing Address - Phone:573-223-4800
Mailing Address - Fax:573-223-2762
Practice Address - Street 1:#1 HAL'S PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957
Practice Address - Country:US
Practice Address - Phone:573-223-4800
Practice Address - Fax:573-223-2762
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017003066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily