Provider Demographics
NPI:1376544221
Name:HOLMES D O FAAFP, BETH A
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:HOLMES D O FAAFP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:HOLMES D O FAAFP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2101 NICHOLASVILLE RD
Mailing Address - Street 2:STE 103
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:40503-2517
Practice Address - Country:US
Practice Address - Phone:859-278-0264
Practice Address - Fax:859-309-5312
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64025273Medicaid
KY64025273Medicaid
G98593Medicare UPIN