Provider Demographics
NPI:1447087432
Name:THOMAS, HOLLY (PMHNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 MEADOW CREST LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-1600
Mailing Address - Country:US
Mailing Address - Phone:636-359-5823
Mailing Address - Fax:
Practice Address - Street 1:1201 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-1612
Practice Address - Country:US
Practice Address - Phone:573-615-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024036138363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health