1871531616 NPI number — DR. TWILA WORLOCK DNP PMHNP

Table of content: DR. TWILA WORLOCK DNP PMHNP (NPI 1871531616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871531616 NPI number — DR. TWILA WORLOCK DNP PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WORLOCK
Provider First Name:
TWILA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CURTICE
Provider Other First Name:
TWILA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871531616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 N ARGONNE RD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99212-6011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-209-8990
Provider Business Mailing Address Fax Number:
509-919-4877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 W FOREST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-541-7070
Provider Business Practice Location Address Fax Number:
731-541-7075
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  104755 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP60868627 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4089638 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 03470247 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3633676 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00216880 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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