Healthcare Provider Details

I. General information

NPI: 1972653889
Provider Name (Legal Business Name): KIMBERLY PAIGE HOLLINGSWORTH BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7511 SE HENRY ST
PORTLAND OR
97206-6445
US

IV. Provider business mailing address

PO BOX 8459
PORTLAND OR
97207-8459
US

V. Phone/Fax

Practice location:
  • Phone: 503-771-6061
  • Fax:
Mailing address:
  • Phone: 503-771-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: