Healthcare Provider Details

I. General information

NPI: 1487913620
Provider Name (Legal Business Name): CHELSEY HOLMES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E 19TH ST SUITE 600
TULSA OK
74104-5405
US

IV. Provider business mailing address

PO BOX 1191
TULSA OK
74101-1191
US

V. Phone/Fax

Practice location:
  • Phone: 918-872-6880
  • Fax: 918-949-6570
Mailing address:
  • Phone: 918-710-4210
  • Fax: 918-949-6584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: