Healthcare Provider Details

I. General information

NPI: 1376442921
Provider Name (Legal Business Name): JUWAN D HOLLOMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 W LA CASA ST
SPRINGFIELD MO
65802-5783
US

IV. Provider business mailing address

4318 W LA CASA ST
SPRINGFIELD MO
65802-5783
US

V. Phone/Fax

Practice location:
  • Phone: 417-419-5057
  • Fax:
Mailing address:
  • Phone: 417-419-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: