Provider Demographics
NPI:1487662649
Name:HOLMES, AMANDA (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20308
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-0308
Mailing Address - Country:US
Mailing Address - Phone:254-751-4880
Mailing Address - Fax:
Practice Address - Street 1:753 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4479
Practice Address - Country:US
Practice Address - Phone:903-609-8828
Practice Address - Fax:903-609-8833
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ85812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N59XOtherBLUE CROSS
TX040476601OtherRAILROAD MEDICARE
TX83987GOtherBLUE CROSS
TX084249401Medicaid
TX040476601Medicaid
TX084249401Medicaid
TX00N59XMedicare PIN