Provider Demographics
NPI:1558091124
Name:HOLMES, JAMIE RENEE (CO61299263)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:RENEE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CO61299263
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:RENEE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2875
Mailing Address - Country:US
Mailing Address - Phone:509-248-1800
Mailing Address - Fax:
Practice Address - Street 1:201 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:BUENA
Practice Address - State:WA
Practice Address - Zip Code:98921-0139
Practice Address - Country:US
Practice Address - Phone:509-865-6705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61299263247000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-0755984Medicaid