Provider Demographics
NPI:1124684451
Name:WORTHY, KEANNA G (DO)
Entity type:Individual
Prefix:DR
First Name:KEANNA
Middle Name:G
Last Name:WORTHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KEANNA
Other - Middle Name:GLORIA
Other - Last Name:WORTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3061 MCNEIL ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8779
Mailing Address - Country:US
Mailing Address - Phone:253-697-1420
Mailing Address - Fax:
Practice Address - Street 1:1322 3RD ST SE STE 240
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3771
Practice Address - Country:US
Practice Address - Phone:253-697-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORBT-18-70458106S00000X
WAOL70024377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician