Healthcare Provider Details

I. General information

NPI: 1801435052
Provider Name (Legal Business Name): REBECCA ELIZABETH HOLT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. REBECCA ELIZABETH CLARK

II. Dates (important events)

Enumeration Date: 01/04/2020
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 NE SAINT LUKES BLVD STE 330
LEES SUMMIT MO
64086-6001
US

IV. Provider business mailing address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-4420
  • Fax: 816-347-4421
Mailing address:
  • Phone: 816-932-5678
  • Fax: 816-932-7957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019023508
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: