Healthcare Provider Details

I. General information

NPI: 1215852496
Provider Name (Legal Business Name): KAREN HOLTZCLAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S MOUNT AUBURN RD
CAPE GIRARDEAU MO
63703-6387
US

IV. Provider business mailing address

2675 WATSON DR
JACKSON MO
63755-3388
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-4151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number2001030468
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: