Provider Demographics
NPI:1386231900
Name:HOLLOWAY, MEDA LUCY
Entity Type:Individual
Prefix:
First Name:MEDA
Middle Name:LUCY
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 NW 530TH RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64061-8118
Mailing Address - Country:US
Mailing Address - Phone:816-392-0267
Mailing Address - Fax:
Practice Address - Street 1:15600 WOODS CHAPEL RD STE A
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64139-1355
Practice Address - Country:US
Practice Address - Phone:816-836-1096
Practice Address - Fax:816-521-4737
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020035582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily