Individual
MR. DOUGLAS P HOLMES JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1801 MARTIN LUTHER KING JR DR, HELENA, AR 72342-8998
(870) 816-3780
(901) 261-2542
Mailing address
PO BOX 771522, MEMPHIS, TN 38177-1522
(901) 747-4624
(901) 261-2542
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R043168
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
C001100
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12605613
CAQH PROVIDER NUMBER
AR
05
—
134707701
—
AR
01
—
1407883721
ARKANSAS BLUE CROSS BLUE SHIELD
AR
Enumeration date
06/26/2006
Last updated
05/18/2015
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