Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP020750 | PA |
NPI | 1003473414 |
---|---|
Provider Name | Kristyn Holmes |
First Address | Grove City, PA 16127-2008 |
Second Address | Butler, PA 16001-1743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 30/09/2019 |