MEDICARE: MARY BRANTLEY HOLMES WHNP

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	363LW0102X	Women's Health Nurse Practitioner	0024164678	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0017137293	OTHER	VA	LICENSED NURSE PRACTITIONER- AUTHORIZATION TO PRESCRIBE
2	0024164678	OTHER	VA	LICENSE TO PRACTICE AS A LISENSED NURSE PRACTITIONER- WOMEN'S HEALTH

General Provider Information

NPI Number	:	1588001556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BRANTLEY HOLMES WHNP

Provider Business Mailing Address
First Line	:	5311 PATTERSON AVE STE A
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2041
Country	:	US
Telephone Number	:	804-916-5096
Fax Number	:	804-800-2118

Provider Business Practice Location Address
First Line	:	5311 PATTERSON AVE STE A
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2041
Country	:	US
Telephone Number	:	804-916-5096
Fax Number	:	804-800-2118

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

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	10/23/2024

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