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NPI Code Detail

MEDICARE: HOLLY UNDERWOOD

MEDICARE: HOLLY UNDERWOOD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse2018044230MO

General Provider Information

NPI Number : 1376493726
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY UNDERWOOD
Provider Business Mailing Address
First Line : 3001 WARRIOR LN
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-8685
Country : US
Telephone Number : 573-686-1200
Fax Number :
Provider Business Practice Location Address
First Line : 3001 WARRIOR LN
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-8685
Country : US
Telephone Number : 573-686-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2026
Last Update Date : 02/03/2026

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Directions to “ HOLLY UNDERWOOD ” Practice Location

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