Basic Information
| Provider Information | |||||||||
| NPI: | 1487662649 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20308 | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767020308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547514880 | ||||||||
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| Practice Location | |||||||||
| Address1: | 753 LAMAR AVE | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754604479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036098828 | ||||||||
| FaxNumber: | 9036098833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | J8581 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 00N59X | 01 | TX | BLUE CROSS | OTHER | 040476601 | 01 | TX | RAILROAD MEDICARE | OTHER | 83987G | 01 | TX | BLUE CROSS | OTHER | 084249401 | 05 | TX | MEDICAID | 040476601 | 05 | TX | MEDICAID |