Healthcare Provider Details

I. General information

NPI: 1649202847
Provider Name (Legal Business Name): HEATHER HOLMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S COULTER ST
AMARILLO TX
79106-1786
US

IV. Provider business mailing address

1400 WALLACE BLVD
AMARILLO TX
79106-1708
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-9650
  • Fax: 806-354-5730
Mailing address:
  • Phone: 806-414-9650
  • Fax: 806-356-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberL3342
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: