Basic Information
| Provider Information | |||||||||
| NPI: | 1578146288 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | J.P. WORNOCK M.D. P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S MAIN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721437801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013680132 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 S MAIN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721437801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012799000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2021 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | FREEMAN | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5013680132 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | J.P. WORNOCK M.D. P.A. | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.