Basic Information
| Provider Information | |||||||||
| NPI: | 1396840476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORSHAM | ||||||||
| FirstName: | RONDA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RNMSNCS FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100B MALLARD SUNRISE DR E | ||||||||
| Address2: | |||||||||
| City: | WESTMORELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371863251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156443000 | ||||||||
| FaxNumber: | 6156443076 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 REDBUD DR STE E | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371489918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153251206 | ||||||||
| FaxNumber: | 6153251245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 10/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | APN0000012147 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 363L00000X | 12147 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | MW1447223 | 01 | DEA | OTHER |