Healthcare Provider Details

I. General information

NPI: 1265976773
Provider Name (Legal Business Name): JAMIE HOLMES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 PRINCETON AVE SW
BIRMINGHAM AL
35211-1320
US

IV. Provider business mailing address

832 PRINCETON AVE SW
BIRMINGHAM AL
35211-1320
US

V. Phone/Fax

Practice location:
  • Phone: 205-397-8906
  • Fax: 205-206-8395
Mailing address:
  • Phone: 205-397-8906
  • Fax: 205-206-8395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-122628
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: