Provider Demographics
NPI:1407239759
Name:HOLMES, KELSEY RHEA (APRN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:RHEA
Last Name:HOLMES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8245
Mailing Address - Country:US
Mailing Address - Phone:904-264-4333
Mailing Address - Fax:904-264-4301
Practice Address - Street 1:4611 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8245
Practice Address - Country:US
Practice Address - Phone:904-264-4333
Practice Address - Fax:904-264-4301
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9329749364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9329749OtherMEDICAL LICENSE