Provider Demographics
NPI:1568850295
Name:HOLMES, WHITNEY M (CPNP)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:M
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 GREENFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1323
Mailing Address - Country:US
Mailing Address - Phone:937-361-6065
Mailing Address - Fax:
Practice Address - Street 1:1483 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-2803
Practice Address - Country:US
Practice Address - Phone:937-667-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA16915363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics