Provider Demographics
NPI:1053657247
Name:HOLLINGSWORTH, KELLI (RDMS)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 BRANCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-5397
Mailing Address - Country:US
Mailing Address - Phone:540-685-3835
Mailing Address - Fax:
Practice Address - Street 1:1420 3RD ST SW STE 1B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-5205
Practice Address - Country:US
Practice Address - Phone:540-685-3835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1334102471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography