Healthcare Provider Details

I. General information

NPI: 1235050980
Provider Name (Legal Business Name): HOLLY ANN WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W 9TH ST STE 601
KANSAS CITY MO
64105-1704
US

IV. Provider business mailing address

20 W 9TH ST STE 601
KANSAS CITY MO
64105-1704
US

V. Phone/Fax

Practice location:
  • Phone: 816-301-4030
  • Fax:
Mailing address:
  • Phone: 816-301-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14859
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2026025212
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: