Provider Demographics
NPI:1457912545
Name:HOLMES, KENYATTA L
Entity Type:Individual
Prefix:
First Name:KENYATTA
Middle Name:L
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W ALABAMA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5177
Mailing Address - Country:US
Mailing Address - Phone:281-509-3924
Mailing Address - Fax:
Practice Address - Street 1:315 W ALABAMA ST STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5177
Practice Address - Country:US
Practice Address - Phone:281-509-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX751068163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84-2229050OtherHOSPICE COMPANY