Provider Demographics
NPI:1275974719
Name:RICHARDSON, HOLLY ROCHELLE (WHNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ROCHELLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ROCHELLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64802-0758
Mailing Address - Country:US
Mailing Address - Phone:417-451-9450
Mailing Address - Fax:417-451-8903
Practice Address - Street 1:530 S MAIDEN LN
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3084
Practice Address - Country:US
Practice Address - Phone:417-782-6200
Practice Address - Fax:417-782-6210
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013024829363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200621430AMedicaid
MO420014318Medicaid