Healthcare Provider Details

I. General information

NPI: 1396123949
Provider Name (Legal Business Name): DECORLA HOLMES LICENSED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 HIGHPOINT RD.
BEDFORD TX
76022
US

IV. Provider business mailing address

1152 HIGHPOINT RD.
BEDFORD TX
76022
US

V. Phone/Fax

Practice location:
  • Phone: 682-227-0821
  • Fax:
Mailing address:
  • Phone: 682-227-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA09046331
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: