MEDICARE: CHRISTY HOLMES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	4042	SC
2	390200000X	Student in an Organized Health Care Education/Training Program
3	363AM0700X	Medical Physician Assistant	0010-11826	NC

General Provider Information

NPI Number	:	1134723802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY HOLMES PA-C

Provider Business Mailing Address
First Line	:	2409 N ELM ST
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-3658
Country	:	US
Telephone Number	:	910-802-4365
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 N ELM ST
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-3658
Country	:	US
Telephone Number	:	910-802-4365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2020
Last Update Date	:	05/25/2022

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Directions to “ CHRISTY HOLMES PA-C” Practice Location

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