Provider Demographics
NPI:1174834741
Name:WORSHAM, PLLC
Entity Type:Organization
Organization Name:WORSHAM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WORSHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, ACNS-BC
Authorized Official - Phone:443-306-8177
Mailing Address - Street 1:129 LEGACY WAY
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5689
Mailing Address - Country:US
Mailing Address - Phone:888-826-2776
Mailing Address - Fax:888-233-1716
Practice Address - Street 1:129 LEGACY WAY
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-5689
Practice Address - Country:US
Practice Address - Phone:888-826-2776
Practice Address - Fax:888-233-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX640929364SA2200X
DCRN1009630364SA2200X
FLCNS 9301281364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty