Provider Demographics
NPI:1689469348
Name:HOLMES, ADRIENNE (MED, LPN)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:HOLMES
Suffix:
Gender:
Credentials:MED, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2792
Mailing Address - Country:US
Mailing Address - Phone:601-562-6146
Mailing Address - Fax:601-562-6146
Practice Address - Street 1:107 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-9276
Practice Address - Country:US
Practice Address - Phone:601-562-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS334824164W00000X
3747P1801X
MS194265251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant