Healthcare Provider Details

I. General information

NPI: 1629468095
Provider Name (Legal Business Name): AMY BETH HOLLER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS AMY BETH DAHN

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9406 E 63RD ST
RAYTOWN MO
64133-4904
US

IV. Provider business mailing address

901 E. 104TH ST. MAILSTOP 400N
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-356-1000
  • Fax:
Mailing address:
  • Phone: 816-502-7104
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015001952
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: