Provider Demographics
NPI:1942964028
Name:HOLMES, OLIVIA (PNP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 OVERLOOK BND
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2978
Mailing Address - Country:US
Mailing Address - Phone:317-997-9177
Mailing Address - Fax:
Practice Address - Street 1:4112 LINKS LN STE 102
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3902
Practice Address - Country:US
Practice Address - Phone:512-930-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1013655363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics