Healthcare Provider Details

I. General information

NPI: 1902720964
Provider Name (Legal Business Name): MICHELLE HOLLINGSWORTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10712 WALNUT HOLLOW DR
OKLAHOMA CITY OK
73162-4053
US

IV. Provider business mailing address

10712 WALNUT HOLLOW DR
OKLAHOMA CITY OK
73162-4053
US

V. Phone/Fax

Practice location:
  • Phone: 405-664-4045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number0110238
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: