Provider Demographics
NPI:1023714672
Name:HOLMES, KIMBERLY NICOLE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NICOLE
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 1:103 TOOMER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920-6905
Mailing Address - Country:US
Mailing Address - Phone:843-441-7935
Mailing Address - Fax:
Practice Address - Street 1:103 TOOMER RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENA ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29920-6905
Practice Address - Country:US
Practice Address - Phone:843-441-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver