Basic Information
| Provider Information | |||||||||
| NPI: | 1043679889 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLLINGSWORTH | ||||||||
| FirstName: | CARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PMHNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FEARNEYHOUGH | ||||||||
| OtherFirstName: | CARA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 532 FAIRHAVEN | ||||||||
| Address2: | |||||||||
| City: | MIDDLETON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836445962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086062658 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9850 W ST LUKES DR | ||||||||
| Address2: | |||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836877912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073711300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2016 | ||||||||
| LastUpdateDate: | 02/22/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 55487 | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.