Provider Demographics
NPI:1265609440
Name:BETH A HOLMES D O FAAFP
Entity type:Organization
Organization Name:BETH A HOLMES D O FAAFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:D O FAAFP
Authorized Official - Phone:859-278-0264
Mailing Address - Street 1:2101 NICHOLASVILLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2517
Mailing Address - Country:US
Mailing Address - Phone:859-278-0264
Mailing Address - Fax:859-309-5312
Practice Address - Street 1:2101 NICHOLASVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2530
Practice Address - Country:US
Practice Address - Phone:859-278-7813
Practice Address - Fax:859-277-2499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH A. HOLMES D O FAAFP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-15
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
LA25717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050440OtherANTHEM
KYC74931OtherUPIN
KYC74931OtherUPIN