Provider Demographics
NPI:1619274933
Name:WHEELER, HOLLIE (FNP)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HOLLIE
Other - Middle Name:
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1523 W BUSINESS HWY 60 1
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841
Mailing Address - Country:US
Mailing Address - Phone:573-614-5762
Mailing Address - Fax:573-614-5806
Practice Address - Street 1:911B W BUSINESS HWY 60
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2741
Practice Address - Country:US
Practice Address - Phone:573-614-5762
Practice Address - Fax:573-614-5806
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011003525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily