Provider Demographics
NPI:1104201623
Name:WORSLEY, JENNIFER L (ARNP FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WORSLEY
Suffix:
Gender:F
Credentials:ARNP FNP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:CARRARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9537 GRAVELLY LAKE DR SW STE E10
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1513
Mailing Address - Country:US
Mailing Address - Phone:253-984-2000
Mailing Address - Fax:253-426-6344
Practice Address - Street 1:9537 GRAVELLY LAKE DR SW STE E10
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1513
Practice Address - Country:US
Practice Address - Phone:253-984-2000
Practice Address - Fax:253-426-6344
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60585208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2047869Medicaid