Provider Demographics
NPI:1326553827
Name:HOLLINGSWORTH, MEGHAN L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:L
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:MEGHAN
Other - Middle Name:L
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 HOWDERSHELL RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-6450
Practice Address - Country:US
Practice Address - Phone:314-687-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027183363L00000X
MO2017040104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner