Shala Renee Holman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1501127 Issued in KS

Practice address

1124 W. 21St Street
Andover, KS 67002

Phone

(316) 300-4000

Fax

(316) 300-4040

NPI assigned

Aug 31, 2006

Last updated

Dec 30, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1230595200000",
    "number": "1275644650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 W. 21ST STREET",
            "city": "ANDOVER",
            "state": "KS",
            "postal_code": "67002",
            "telephone_number": "316-300-4000",
            "fax_number": "316-300-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 W. 21ST STREET",
            "city": "ANDOVER",
            "state": "KS",
            "postal_code": "67002",
            "telephone_number": "316-300-4000",
            "fax_number": "316-300-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMAN",
        "first_name": "SHALA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "1073264",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "1501127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200414050B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "427052",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelly Herrmann, OTR/L
• Kelsey Marie Highbarger
• Misty Michelle Hinton, M.A, CCC-SLP
• Holding Hope Counseling, LLC.
• Sydney Marie Holland, PA
• Homestead Health and Wellness
• Morgan L Hook, MS RD LD
• Hospitalist Medicine Physicians of Kansas - TCS LLC
• Matthew Daniel Howell, DDS
• Casey T Hummel

• Physician Assistant in Andover, KS
• Providers in Andover, KS by specialty
• Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.