Provider Demographics
NPI:1558024174
Name:HOLLINGSWORTH, KRYSTAL (LPN)
Entity Type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:HOLLINGSWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:3629 S D ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-6813
Mailing Address - Country:US
Mailing Address - Phone:253-649-1406
Mailing Address - Fax:
Practice Address - Street 1:3629 S D ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-6813
Practice Address - Country:US
Practice Address - Phone:253-649-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60591430164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse