Healthcare Provider Details

I. General information

NPI: 1861528432
Provider Name (Legal Business Name): HOLLY LYNN WHERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BRANSON LANDING BLVD STE 508
BRANSON MO
65616
US

IV. Provider business mailing address

525 BRANSON LANDING BLVD STE 508
BRANSON MO
65616
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-7540
  • Fax:
Mailing address:
  • Phone: 417-335-7540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2005019470
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: