Individual
MRS. REGINA F. HOLMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
AGAPE SENIOR PRIMARY CARE INC DBA MAIN STREET PHYSICIAN, 3612 MITCHELL STREET, LORIS, SC 29569
(843) 756-2122
(843) 756-2121
Mailing address
1053 CENTER STREET, ATTENTION: CREDENTIALING DEPARTMENT, WEST COLUMBIA, SC 29169
(800) 726-2350
(843) 716-7195
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F4220
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP1730
—
SC
Enumeration date
05/24/2010
Last updated
12/06/2018
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