Basic Information
| Provider Information | |||||||||
| NPI: | 1639340987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORRELL | ||||||||
| FirstName: | NIKKIA | ||||||||
| MiddleName: | HENDERSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HENDERSON | ||||||||
| OtherFirstName: | NIKKIA | ||||||||
| OtherMiddleName: | ROCHELLE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 915 TATE BLVD SE | ||||||||
| Address2: | STE 170 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283450800 | ||||||||
| FaxNumber: | 8283450350 | ||||||||
| Practice Location | |||||||||
| Address1: | 915 TATE BLVD SE | ||||||||
| Address2: | STE 170 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283450800 | ||||||||
| FaxNumber: | 8283450350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2008 | ||||||||
| LastUpdateDate: | 05/18/2015 | ||||||||
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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 | 207V00000X | 001356 | GA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 42473 | AZ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | 2012-01608 | NC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207V00000X | 2012-01608 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 5921465 | 05 | NC | MEDICAID |