Healthcare Provider Details

I. General information

NPI: 1932981073
Provider Name (Legal Business Name): TAYLOR REANN HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S REILLY RD
FAYETTEVILLE NC
28314-1825
US

IV. Provider business mailing address

402 HARRIS AVE
RAEFORD NC
28376-3112
US

V. Phone/Fax

Practice location:
  • Phone: 910-491-6356
  • Fax:
Mailing address:
  • Phone: 910-875-5590
  • Fax: 910-875-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP019335
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: