Provider Demographics
NPI:1841577913
Name:HOLMES, MEREDITH ANN (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:ANN
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 VICKIE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-4266
Mailing Address - Country:US
Mailing Address - Phone:214-668-2801
Mailing Address - Fax:
Practice Address - Street 1:9708 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5150
Practice Address - Country:US
Practice Address - Phone:214-932-1958
Practice Address - Fax:214-932-1977
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256069364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB163508Medicare PIN
TXTXB163507Medicare PIN
TXTXB163506Medicare PIN