Provider Demographics
NPI:1578146288
Name:J.P. WORNOCK M.D. P.A.
Entity Type:Organization
Organization Name:J.P. WORNOCK M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-368-0132
Mailing Address - Street 1:400 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7801
Mailing Address - Country:US
Mailing Address - Phone:501-368-0132
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7801
Practice Address - Country:US
Practice Address - Phone:501-279-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J.P. WORNOCK M.D. P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health