Healthcare Provider Details

I. General information

NPI: 1245578129
Provider Name (Legal Business Name): TAMMI HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N HANLEY RD
SAINT LOUIS MO
63134-2003
US

IV. Provider business mailing address

6121 N HANLEY RD
SAINT LOUIS MO
63134-2003
US

V. Phone/Fax

Practice location:
  • Phone: 314-615-1643
  • Fax:
Mailing address:
  • Phone: 314-615-1643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number090319-300002327
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: