MEDICARE: KIRSTEN A 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	363A00000X	Physician Assistant	PA00532	OR
2	363A00000X	Physician Assistant	PA10003545	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194918409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN A HOLMES PA-C

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:	503-215-6644

Provider Business Practice Location Address
First Line	:	101 NW 12TH AVE
Second Line	:	STE 107
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-9141
Country	:	US
Telephone Number	:	360-687-6650
Fax Number	:	360-514-6820

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

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	10/14/2020

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Directions to “ KIRSTEN A HOLMES PA-C” Practice Location

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