Individual
HOLLY REBECCA HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
405 E NIFONG BLVD, COLUMBIA, MO 65201-3708
(573) 884-0146
(573) 884-1066
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1172455
MO
363A00000X
Physician Assistant
Primary
2022003496
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220108653
—
MO
Enumeration date
01/16/2022
Last updated
06/15/2022
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