Provider Demographics
NPI:1790383719
Name:HOLLINGSWORTH, KAYTLIN BLAKE (PA-C)
Entity type:Individual
Prefix:
First Name:KAYTLIN
Middle Name:BLAKE
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:92 SPRINGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8153
Mailing Address - Country:US
Mailing Address - Phone:843-871-4006
Mailing Address - Fax:843-871-4074
Practice Address - Street 1:92 SPRINGVIEW LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8153
Practice Address - Country:US
Practice Address - Phone:843-871-4006
Practice Address - Fax:843-871-4074
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC3739363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant