MEDICARE: HOLLY MCCLELLAN NREMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1962347807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY MCCLELLAN NREMT

Provider Business Mailing Address
First Line	:	5727 DE GIVERVILLE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-1614
Country	:	US
Telephone Number	:	636-600-3294
Fax Number	:

Provider Business Practice Location Address
First Line	:	5727 DE GIVERVILLE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63112-1614
Country	:	US
Telephone Number	:	636-600-3294
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ HOLLY MCCLELLAN NREMT” Practice Location

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