Healthcare Provider Details

I. General information

NPI: 1962347807
Provider Name (Legal Business Name): HOLLY MCCLELLAN NREMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5727 DE GIVERVILLE AVE
SAINT LOUIS MO
63112-1614
US

IV. Provider business mailing address

5727 DE GIVERVILLE AVE
SAINT LOUIS MO
63112-1614
US

V. Phone/Fax

Practice location:
  • Phone: 636-600-3294
  • Fax:
Mailing address:
  • Phone: 636-600-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: