Individual provider Active NPI

Courtney Danielle Holmes, APRN

  • Adult Health Nurse Practitioner
  • Farmington, CT
National Provider Identifier
1114922069
Registry record updated Sep 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
002689 Issued in CT
Practice address
Uconn Medical Group
263 Farmington Avenue
Farmington, CT 06030-0001
Phone
(860) 679-8400
Fax
(860) 679-8188
NPI assigned
Jun 16, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 002689 CT Primary

Addresses

Primary practice location

Uconn Medical Group
263 Farmington Avenue
Farmington, CT 06030-0001

Mailing address

Uconn Medical Group
263 Farmington Avenue
Farmington, CT 06030-0001
Phone (860) 679-8400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050715000482 CT Practitioner - Nurse Practitioner 4880620350

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2689CTMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
NP Care, LLC Past Accepting new patients
University of Connecticut Health Center Past Accepting new patients
Medoptions Behavioral Health Assoc, LLC Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473292800000",
    "number": "1114922069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UCONN MEDICAL GROUP",
            "address_2": "263 FARMINGTON AVENUE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-8400",
            "fax_number": "860-679-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UCONN MEDICAL GROUP",
            "address_2": "263 FARMINGTON AVENUE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-8400",
            "fax_number": "860-679-8188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "COURTNEY",
        "middle_name": "DANIELLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-16",
        "last_updated": "2016-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": "002689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.