MEDICARE: TERESA S HOLMES

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	374U00000X	Home Health Aide		MS

General Provider Information

NPI Number	:	1417518929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA S HOLMES

Provider Business Mailing Address
First Line	:	3406 REDMOND AVE
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39213-5621
Country	:	US
Telephone Number	:	601-519-7243
Fax Number	:

Provider Business Practice Location Address
First Line	:	3406 REDMOND AVE
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39213-5621
Country	:	US
Telephone Number	:	601-519-7243
Fax Number	:

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	06/25/2019

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Directions to “ TERESA S HOLMES ” Practice Location

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