Healthcare Provider Details

I. General information

NPI: 1407239759
Provider Name (Legal Business Name): KELSEY RHEA HOLMES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 09/15/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 US HIGHWAY 17
FLEMING ISLAND FL
32003-8245
US

IV. Provider business mailing address

4611 US HIGHWAY 17
FLEMING ISLAND FL
32003-8245
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-4333
  • Fax: 904-264-4301
Mailing address:
  • Phone: 904-264-4333
  • Fax: 904-264-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberARNP9329749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: