Provider Demographics
NPI:1831374941
Name:HOLMES, ROBERTA LEE
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LEE
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 1:309 E MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:KS
Mailing Address - Zip Code:66021-9269
Mailing Address - Country:US
Mailing Address - Phone:816-255-5332
Mailing Address - Fax:
Practice Address - Street 1:309 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:KS
Practice Address - Zip Code:66021-9269
Practice Address - Country:US
Practice Address - Phone:816-255-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant