Healthcare Provider Details

I. General information

NPI: 1033073952
Provider Name (Legal Business Name): KTICE KARYONE HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 SANDRA AVE
HARRISBURG PA
17109-5817
US

IV. Provider business mailing address

613 SANDRA AVE
HARRISBURG PA
17109-5817
US

V. Phone/Fax

Practice location:
  • Phone: 223-225-0668
  • Fax: 223-225-0668
Mailing address:
  • Phone: 223-225-0668
  • Fax: 223-225-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number76503601
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: