Provider Demographics
NPI:1952865552
Name:HOLMES, KATIE C (RNFA, NP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:C
Last Name:HOLMES
Suffix:
Gender:F
Credentials:RNFA, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2216
Mailing Address - Country:US
Mailing Address - Phone:409-838-0346
Mailing Address - Fax:409-839-3720
Practice Address - Street 1:3650 LAUREL ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2216
Practice Address - Country:US
Practice Address - Phone:409-838-0346
Practice Address - Fax:409-839-3720
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX803415163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX803415OtherREGISTERED NURSE