Basic Information
| Provider Information | |||||||||
| NPI: | 1386231900 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLOWAY | ||||||||
| FirstName: | MEDA | ||||||||
| MiddleName: | LUCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1843 NW 530TH RD | ||||||||
| Address2: | |||||||||
| City: | KINGSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640618118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163920267 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15600 WOODS CHAPEL RD STE A | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641391355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168361096 | ||||||||
| FaxNumber: | 8165214737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2020 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2020035582 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.