=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215852496
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN HOLTZCLAW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2026
-----------------------------------------------------
Last Update Date | 08/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 S MOUNT AUBURN RD
-----------------------------------------------------
City | CAPE GIRARDEAU
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63703-6387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-686-4151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2675 WATSON DR
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63755-3388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Registered Nurse
-----------------------------------------------------
License Number | 2001030468
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------