Provider Demographics
NPI:1396826251
Name:HOLMES, SUSAN (MP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N 20TH ST
Mailing Address - Street 2:#6
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5449
Mailing Address - Country:US
Mailing Address - Phone:334-749-3385
Mailing Address - Fax:334-742-9243
Practice Address - Street 1:121 N 20TH ST
Practice Address - Street 2:#6
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5449
Practice Address - Country:US
Practice Address - Phone:334-749-3385
Practice Address - Fax:334-742-9243
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-039701363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS93253Medicare UPIN