Provider Demographics
NPI:1558602003
Name:HOLLINGSWORTH, KELLEY M (LPN)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:M
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 ROBERTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655
Mailing Address - Country:US
Mailing Address - Phone:870-367-2461
Mailing Address - Fax:870-460-6133
Practice Address - Street 1:1404 EAST CHURCH STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671
Practice Address - Country:US
Practice Address - Phone:870-226-5856
Practice Address - Fax:870-226-6208
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL51305164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse