Healthcare Provider Details

I. General information

NPI: 1801715735
Provider Name (Legal Business Name): TENESHA LATRECE HOLLIGAN AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-5430
  • Fax: 816-407-5435
Mailing address:
  • Phone: 816-407-5430
  • Fax: 816-407-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2026033378
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: