Healthcare Provider Details

I. General information

NPI: 1003303389
Provider Name (Legal Business Name): HOLLY ACKERMANN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2018
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 E GANNON DR
FESTUS MO
63028-2611
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-2551
US

V. Phone/Fax

Practice location:
  • Phone: 636-282-0380
  • Fax: 636-282-0384
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2018010406
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018010406
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018010406
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: