| Doctor Name: | HOLLY WILDS |
| NPI Number: | 1326487414 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 2013019754 |
| Business Practice Address: | 1200 W 22nd St Higginsville, MO - 640371420 |
| Business Phone Number: | 6605847751 |
| Business Fax Number: | |
| Mailing Address: | 1200 W 22nd St, HIGGINSVILLE |
| State: | MO |
| Postal Code: | 640371420 |
| Phone Number: | 6605847751 |
| Fax Number: | |
| NPI Enumeration Date: | 06/21/2013 |
| NPI Last Update Date: | 09/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2013019754 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |