Provider Demographics
NPI:1740818954
Name:HOLMES, KELSIE MARIE (DO)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:MARIE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1115 S MARSHALL STREET
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-5304
Mailing Address - Country:US
Mailing Address - Phone:515-432-2335
Mailing Address - Fax:515-432-2357
Practice Address - Street 1:1115 S MARSHALL STREET
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-5304
Practice Address - Country:US
Practice Address - Phone:515-432-2335
Practice Address - Fax:515-432-2357
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61435796207Q00000X
390200000X
IADO06796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program