Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 20150 | TN |
NPI | 1003291683 |
---|---|
Provider Name | Mrs. Carrie James Worsham |
First Address | Hernando, MS 38632-2456 |
Second Address | Hernando, MS 38632-2456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2015 |
Last Update Date | 17/03/2018 |