Healthcare Provider Details

I. General information

NPI: 1538634290
Provider Name (Legal Business Name): KIMBERLY LYNN HOLMES MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR # H044
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-8395
  • Fax: 717-531-5726
Mailing address:
  • Phone: 717-531-8395
  • Fax: 717-531-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN283977L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: