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General NPI Number Information
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NPI Number | 1982244968
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Entity Type | Individual
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Provider Name | KELLY A HOLMES
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Gender | Female
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 22001 JAMAICA AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-2140
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Country | US
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Telephone | 718-412-1848
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Fax |
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Provider Business Mailing Address
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Address Line | 12 BROOKLYN AVE APT 501
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City | VALLEY STREAM
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State | NY
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Zip | 11581-1287
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Country | US
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Telephone | 929-404-1011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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