=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447087432
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLY THOMAS PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2024
-----------------------------------------------------
Last Update Date | 09/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1225 AGUILAR DR
-----------------------------------------------------
City | MONTGOMERY CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63361-2723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-582-1234
-----------------------------------------------------
Fax | 573-582-1212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 504 MEADOW CREST LN
-----------------------------------------------------
City | MONTGOMERY CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63361-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-359-5823
-----------------------------------------------------
Fax | 573-582-1212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 2024036138
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------