MRS. SHALA RENEE HOLMAN (NPI# 1275644650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275644650 |
| Entity Type | Individual |
| Full Name | MRS. SHALA RENEE HOLMAN |
| Credential | PA-C |
| Practice Address |
1124 W. 21st Street Andover KS 67002 |
| Practice Telephone | 3163004000 |
| Practice Fax Number | 3163004040 |
| Mailing Telephone | 3163004000 |
| Mailing Fax Number | 3163004040 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-12-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1501127 | KS | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 1073264 | KS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | BCBS | 427052 | 01 |
| KS | 200414050B | 05 |
| Street Address |
1124 W. 21ST STREET |
| City | ANDOVER |
| State | KS |
| Zip Code | 67002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386262707 | Rachel Marie Porter | Nurse Practitioner | Andover Family Medicine, 2117 N Keystone Circle, Andover, KS 67002 | 2020-07-13 |
| 1033535695 | Michael L Ray | Chiropractor | 1145 N Andover Rd Ste 109, Andover, KS 67002 | 2014-03-06 |
| 1225372949 | Lisa Hua Lee | Physical Therapy Assistant | 811 N Crescent Lakes Cir, Andover, KS 67002 | 2012-11-19 |
| 1689992752 | Andover Senior Care, LLC | Skilled Nursing Facility | 224 E Central Ave, Andover, KS 67002 | 2010-05-13 |
| 1033303136 | Casey T Hummel | Chiropractor | 550 North Andover Road, Andover, KS 67002 | 2007-08-31 |
| 1801007786 | Kansas Medical Center, LLC | Family Medicine | 1124 W. 21st St, Andover, KS 67002 | 2007-05-24 |
| 1205929957 | Sitha Uy Miller | Internal Medicine | 943 N. Andover Road, Andover, KS 67002 | 2006-10-02 |
| 1497869168 | Allan Michael Weilert | Chiropractor | 202 E Rhondda St, Ste A, Andover, KS 67002 | 2006-08-18 |
| 1407872708 | Lindsay Marie Landers | Family Medicine | 105 S Andover Rd, Suite D, Andover, KS 67002 | 2006-07-14 |
| 1295770782 | Ashley Ralston | Optometrist | 308 E Central Ave Ste 100, Andover, KS 67002 | 2006-06-18 |
| Find all providers in zip 67002 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932677473 | Jessica Howie | Physician Assistant | 28 Andover St Fl 1, Andover, MA 01810 | 2018-11-02 |
| 1588625495 | Catherine A Scheve | Physician Assistant | 308 E Central, Andover, KS 67002 | 2006-03-30 |
| 1053372037 | Jill L Johnson-smith | Physician Assistant | 612 N Andover Rd, Andover, KS 67002-9778 | 2006-03-30 |
| 1013551969 | Ciara Nicole Weaver | Physician Assistant | 149 E Main St, Andover, OH 44003-9479 | 2019-11-04 |
| 1922653179 | Matthew James Sullivan | Physician Assistant | 323 Lowell St, Andover, MA 01810-4659 | 2019-08-05 |
| 1457820912 | Jason Emold Nesler | Physician Assistant | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2018-11-14 |
| 1831667484 | Therese Diola | Physician Assistant | 323 Lowell St, Andover, MA 01810-4501 | 2018-11-12 |
| 1750856647 | John O'shea | Physician Assistant | 323 Lowell Street, West Wing, 1st Floor, Andover, MA 01810 | 2018-10-08 |
| 1548763766 | Marco Christian Montecalvo | Physician Assistant | 323 Lowell St, Andover, MA 01810-4501 | 2018-03-14 |
| 1306345244 | Gregory Joseph Parks | Physician Assistant | 323 Lowell St, Andover, MA 01810-4501 | 2018-02-06 |
| Find all providers in ANDOVER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.