Provider Demographics
NPI:1295453660
Name:FREEMAN, MOLLY ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:MINNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17701 TALON DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MO
Mailing Address - Zip Code:64048-8847
Mailing Address - Country:US
Mailing Address - Phone:816-694-6331
Mailing Address - Fax:
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:KS
Practice Address - Zip Code:66512-9578
Practice Address - Country:US
Practice Address - Phone:785-484-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022008524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily