Provider Demographics
NPI:1407307788
Name:JP WORNOCK, MD, PA
Entity Type:Organization
Organization Name:JP WORNOCK, MD, PA
Other - Org Name:PRIMECARE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HUMAN CAPITAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-764-1800
Mailing Address - Street 1:2504 MCCAIN BLVD
Mailing Address - Street 2:STE 118
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7607
Mailing Address - Country:US
Mailing Address - Phone:501-812-6655
Mailing Address - Fax:501-812-6677
Practice Address - Street 1:2504 MCCAIN BLVD
Practice Address - Street 2:STE 118
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7607
Practice Address - Country:US
Practice Address - Phone:501-812-6655
Practice Address - Fax:501-812-6677
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JP WORNOCK, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARBL2016-00512261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center