Provider Demographics
NPI:1568543213
Name:WORSHAM, KYLE AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:AUSTIN
Last Name:WORSHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 LEGION RD
Mailing Address - Street 2:SUITE 200-B
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2375
Mailing Address - Country:US
Mailing Address - Phone:919-960-3133
Mailing Address - Fax:919-960-3135
Practice Address - Street 1:1709 LEGION RD
Practice Address - Street 2:SUITE 200-B
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2375
Practice Address - Country:US
Practice Address - Phone:919-960-3133
Practice Address - Fax:919-960-3135
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94013632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1027HOtherBCBS
NC1027HOtherBCBS