Individual provider Active NPI

Chanda Quinn Holmes, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Selma, TX
National Provider Identifier
1811228356
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
1143403 Issued in TX
Practice address
3509 Treeline Acres
Selma, TX 78154-1964
Phone
(916) 206-1772
NPI assigned
Jan 22, 2010
Last updated
Jan 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 708318 TX
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 1143403 TX Primary

Addresses

Primary practice location

3509 Treeline Acres
Selma, TX 78154-1964

Mailing address

3509 Treeline Acres
Selma, TX 78154-1964
Phone (916) 206-1772

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20240424000782 TX Practitioner - Nurse Practitioner 7618316696

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
708318TXMDRegistered Nurse

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1811228356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3509 TREELINE ACRES",
            "city": "SELMA",
            "state": "TX",
            "postal_code": "781541964",
            "telephone_number": "916-206-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 TREELINE ACRES",
            "city": "SELMA",
            "state": "TX",
            "postal_code": "781541964",
            "telephone_number": "916-206-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "CHANDA",
        "middle_name": "QUINN",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-22",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "708318",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1143403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Selma, TX

Sources for this page

Verify at the official NPI Registry.