Provider Demographics
NPI:1366022246
Name:HOLLINGSWORTH, HEATHER ROBERSON (RN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ROBERSON
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 LON GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-9555
Mailing Address - Country:US
Mailing Address - Phone:601-938-3179
Mailing Address - Fax:
Practice Address - Street 1:6280 LON GOODMAN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-9555
Practice Address - Country:US
Practice Address - Phone:601-938-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR885055163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse