MEDICARE: MRS. AMANDA LYNN 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	237700000X	Hearing Instrument Specialist	2350	AL

General Provider Information

NPI Number	:	1659054690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LYNN HOLMES

Provider Business Mailing Address
First Line	:	2202 GATEWAY DR STE B
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-6870
Country	:	US
Telephone Number	:	936-591-7942
Fax Number	:

Provider Business Practice Location Address
First Line	:	2202 GATEWAY DR STE B
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-6870
Country	:	US
Telephone Number	:	936-591-7942
Fax Number	:

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

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	08/08/2023

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