Provider Demographics
NPI:1467644856
Name:HOLMES-BRANTON, KATHY A (LMT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:HOLMES-BRANTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4717
Mailing Address - Country:US
Mailing Address - Phone:850-432-5187
Mailing Address - Fax:
Practice Address - Street 1:2100 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4717
Practice Address - Country:US
Practice Address - Phone:850-432-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#0018278174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC-7201OtherBLUECROSS/BLUESHIELD