Healthcare Provider Details

I. General information

NPI: 1437036092
Provider Name (Legal Business Name): HOLLY ELAINE SANDERSON MS, PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 19TH TER
KANSAS CITY MO
64108-2026
US

IV. Provider business mailing address

300 W 19TH TER
KANSAS CITY MO
64108-2026
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-5732
  • Fax:
Mailing address:
  • Phone: 816-404-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2025035045
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: