Provider Demographics
NPI:1902553407
Name:JULIAN, HOLLY A (PMHNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:JULIAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:DIMMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1965 S FREMONT AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2295
Mailing Address - Country:US
Mailing Address - Phone:417-820-3128
Mailing Address - Fax:
Practice Address - Street 1:1965 S FREMONT AVE STE 310
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2295
Practice Address - Country:US
Practice Address - Phone:417-820-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022006635363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health