Provider Demographics
NPI:1588001556
Name:HOLMES, MARY BRANTLEY (WHNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BRANTLEY
Last Name:HOLMES
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 PATTERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2041
Mailing Address - Country:US
Mailing Address - Phone:804-916-5096
Mailing Address - Fax:804-800-2118
Practice Address - Street 1:5311 PATTERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2041
Practice Address - Country:US
Practice Address - Phone:804-916-5096
Practice Address - Fax:804-800-2118
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164678363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0017137293OtherLICENSED NURSE PRACTITIONER- AUTHORIZATION TO PRESCRIBE
VA0024164678OtherLICENSE TO PRACTICE AS A LISENSED NURSE PRACTITIONER- WOMEN'S HEALTH