Healthcare Provider Details

I. General information

NPI: 1457851776
Provider Name (Legal Business Name): KIMBERLY KAY HOLMES APRN, ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST STE 150
DOVER DE
19904-3491
US

IV. Provider business mailing address

640 S STATE ST MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-6592
  • Fax: 302-735-3240
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SN0800X
TaxonomyNeuroscience Clinical Nurse Specialist
License NumberL9-0000120
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberL9-0000120
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: