Provider Demographics
NPI:1265474498
Name:DEAN, HOLLY A (PA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:DEAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-7272
Mailing Address - Fax:417-347-7915
Practice Address - Street 1:3302 MCINTOSH CIR
Practice Address - Street 2:STE 1
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3648
Practice Address - Country:US
Practice Address - Phone:417-347-7272
Practice Address - Fax:417-347-7915
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005034529363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q56239Medicare UPIN