Provider Demographics
NPI:1558856807
Name:HOLMES, ELIZABETH ELEANOR (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELEANOR
Last Name:HOLMES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 JENNY LIND RD STE A
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-7632
Mailing Address - Country:US
Mailing Address - Phone:479-484-1010
Mailing Address - Fax:479-484-9595
Practice Address - Street 1:4200 JENNY LIND RD STE A
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7632
Practice Address - Country:US
Practice Address - Phone:479-484-1010
Practice Address - Fax:479-484-9595
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005657363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care