MEDICARE: KELLY BRITTAIN 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	363LF0000X	Family Nurse Practitioner	5016357	NC

General Provider Information

NPI Number	:	1548991565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BRITTAIN HOLMES

Provider Business Mailing Address
First Line	:	PO BOX 1845
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28687-1845
Country	:	US
Telephone Number	:	170-487-3427
Fax Number	:

Provider Business Practice Location Address
First Line	:	2660 TATE BLVD SE STE 202
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-1466
Country	:	US
Telephone Number	:	704-978-1145
Fax Number	:

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

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/21/2022

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