Provider Demographics
NPI:1407186117
Name:HOLMES, VERLEATA LASHONNE
Entity Type:Individual
Prefix:
First Name:VERLEATA
Middle Name:LASHONNE
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 1:1501 THOMAS AVE
Mailing Address - Street 2:APT 12
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-4736
Mailing Address - Country:US
Mailing Address - Phone:816-606-6920
Mailing Address - Fax:
Practice Address - Street 1:1501 THOMAS AVE
Practice Address - Street 2:APT 12
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-4736
Practice Address - Country:US
Practice Address - Phone:816-606-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374U00000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32358609Medicaid