Individual provider Active NPI

Krystal Hollingsworth, LPN

  • Licensed Practical Nurse
  • Tacoma, WA
National Provider Identifier
1558024174
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
LP60591430 Issued in WA
Practice address
3629 S D St
Tacoma, WA 98418-6813
Phone
(253) 649-1406
NPI assigned
Oct 20, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X LP60591430 WA Primary

Addresses

Primary practice location

3629 S D St
Tacoma, WA 98418-6813

Mailing address

3629 S D St
Tacoma, WA 98418-6813
Phone (253) 649-1406

Other names 1

  • Ms. Krystal Hollingsworth Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LP60591430WAMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1558024174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3629 S D ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984186813",
            "telephone_number": "253-649-1406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3629 S D ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984186813",
            "telephone_number": "253-649-1406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLINGSWORTH",
        "first_name": "KRYSTAL",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-20",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WA",
            "license": "LP60591430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTAL",
            "last_name": "HOLLINGSWORTH",
            "prefix": "MS.",
            "credential": "LPN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.