Provider Demographics
NPI:1649162363
Name:HOLMES, KENDRA NICOLE
Entity type:Individual
Prefix:
First Name:KENDRA
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 1:144 WEDGE WOOD CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-6884
Mailing Address - Country:US
Mailing Address - Phone:912-602-4953
Mailing Address - Fax:912-452-1171
Practice Address - Street 1:144 WEDGE WOOD CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-6884
Practice Address - Country:US
Practice Address - Phone:912-602-4953
Practice Address - Fax:912-452-1171
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies