Basic Information
| Provider Information | |||||||||
| NPI: | 1477519924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORF | ||||||||
| FirstName: | TERRI | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 N MAIN ST | ||||||||
| Address2: | P O BOX 1133 | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678465400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202768201 | ||||||||
| FaxNumber: | 6202750712 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 678465400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202768201 | ||||||||
| FaxNumber: | 6202750712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 03/26/2010 | ||||||||
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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 | 363L00000X | 13-64331-010 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 45394 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 100088530B | 05 | KS | MEDICAID |