Shane Holloway, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2016044506 Issued in MO

Practice address

1401 Forum Blvd Ste 202
Columbia, MO 65203-1915

Phone

(573) 234-1367

NPI assigned

Jan 9, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shane.holloway.1@10672.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Renova Medical Center, LLC

  • General Practice Physician
  • Columbia, MO
  • NPI 1447741681
  Medicare reassignment NPD
• Rose Family Chiropractic LLC

  • Chiropractor
  • Columbia, MO
  • NPI 1902109622
  NPD (past)

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1821534231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 FORUM BLVD STE 202",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652031915",
            "telephone_number": "573-234-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 FORUM BLVD STE 202",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652031915",
            "telephone_number": "573-234-1367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLOWAY",
        "first_name": "SHANE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-09",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2016044506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Marie Holland, RDH
• Joy Renee Hollandsworth, RD
• Kaitlyn McKenzie Hollenberg, PHARMD
• Zachary Michael Holliday, M.D.
• Pamela A Hollins, EDD, LPC
• Jason Grant Holman, MD
• Brett W Holmes, PHARM. D.
• Peter F Holmes, PHD
• Sarah Elizabeth Holmes, LCSW
• Andrea Lynn Holt, MSW, LCSW

• Nurse Practitioner in Columbia, MO
• Providers in Columbia, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.