MEDICARE: HEATHER CATHLEEN HOLLANDSWORTH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	20529	PA
2	363LF0000X	Family Nurse Practitioner	APN20903APRN	SC
3	363LF0000X	Family Nurse Practitioner	F342160-1	NY
4	363LF0000X	Family Nurse Practitioner	5015573	NC

General Provider Information

NPI Number	:	1205352762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER CATHLEEN HOLLANDSWORTH FNP

Provider Business Mailing Address
First Line	:	2111 E STATE ST
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-2138
Country	:	US
Telephone Number	:	740-566-4621
Fax Number	:	740-566-4622

Provider Business Practice Location Address
First Line	:	485 TOM HALL ST STE 101
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-2353
Country	:	US
Telephone Number	:	803-228-7972
Fax Number	:	803-228-7974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	01/27/2026

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