Healthcare Provider Details

I. General information

NPI: 1295645943
Provider Name (Legal Business Name): KIMARIE NICOLE HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5408 AMES AVE
OMAHA NE
68104
US

IV. Provider business mailing address

1005 N 20TH ST APT 410
OMAHA NE
68102-4315
US

V. Phone/Fax

Practice location:
  • Phone: 210-956-6113
  • Fax:
Mailing address:
  • Phone: 210-956-6113
  • Fax: 210-956-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: