Provider Demographics
NPI:1417452947
Name:HOLLINGSWORTH, KAITLYN ANNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANNE
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13345 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3318
Mailing Address - Country:US
Mailing Address - Phone:317-396-1300
Mailing Address - Fax:317-352-3417
Practice Address - Street 1:555 E COUNTY LINE RD STE 202
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1063
Practice Address - Country:US
Practice Address - Phone:317-396-1300
Practice Address - Fax:317-396-1419
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28181128A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily