Provider Demographics
NPI:1407883721
Name:HOLMES, DOUGLAS P JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:P
Last Name:HOLMES
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 771522
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-1522
Mailing Address - Country:US
Mailing Address - Phone:901-747-4624
Mailing Address - Fax:901-261-2542
Practice Address - Street 1:1801 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-8998
Practice Address - Country:US
Practice Address - Phone:870-816-3780
Practice Address - Fax:901-261-2542
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARR043168163W00000X
ARC001100367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1407883721OtherARKANSAS BLUE CROSS BLUE SHIELD
AR12605613OtherCAQH PROVIDER NUMBER
AR1407883721OtherBAPTIST HEALTH SERVICES GROUP, INC.
AR134707701Medicaid
AR1407883721OtherBAPTIST HEALTH SERVICES GROUP, INC.