Provider Demographics
NPI:1760402234
Name:HOLLINGSHEAD, DAVID SCOTT (APRN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:HOLLINGSHEAD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E. 700 S.
Mailing Address - Street 2:SUITE B205
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-275-3945
Mailing Address - Fax:844-742-6572
Practice Address - Street 1:640 E. 700 S.
Practice Address - Street 2:SUITE B205
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-275-3945
Practice Address - Fax:844-742-6572
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2132164405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005767312Medicare PIN