Provider Demographics
NPI:1003291683
Name:WORSHAM, CARRIE JAMES (NP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JAMES
Last Name:WORSHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:JAMES
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3102 GOODMAN RD W
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-1172
Mailing Address - Country:US
Mailing Address - Phone:662-344-2667
Mailing Address - Fax:662-342-1213
Practice Address - Street 1:3102 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1172
Practice Address - Country:US
Practice Address - Phone:662-342-6677
Practice Address - Fax:662-342-1213
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily