Provider Demographics
NPI:1275141186
Name:HOLMES, PRECIOUS
Entity Type:Individual
Prefix:
First Name:PRECIOUS
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 1:1321 SUNSET DR STE A
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4005
Mailing Address - Country:US
Mailing Address - Phone:662-307-2803
Mailing Address - Fax:
Practice Address - Street 1:1321 SUNSET DR STE A
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4005
Practice Address - Country:US
Practice Address - Phone:662-307-2803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide