Individual
MRS. SHALA RENEE HOLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1124 W. 21ST STREET, ANDOVER, KS 67002
(316) 300-4000
(316) 300-4040
Mailing address
1124 W. 21ST STREET, ANDOVER, KS 67002
(316) 300-4000
(316) 300-4040
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1073264
KS
363A00000X
Physician Assistant
Primary
1501127
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200414050B
—
KS
01
—
427052
BCBS
KS
Enumeration date
08/31/2006
Last updated
12/30/2008
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