Provider Demographics
NPI:1518598846
Name:HOLMES, JOHANNA MARIE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:MARIE
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 ISAAC CT
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-5400
Mailing Address - Country:US
Mailing Address - Phone:724-554-9501
Mailing Address - Fax:
Practice Address - Street 1:109 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-4940
Practice Address - Country:US
Practice Address - Phone:940-654-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily