Provider Demographics
NPI:1710294947
Name:WORLEY, NICHOLAS S (PA-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:S
Last Name:WORLEY
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:5255 E STOP 11 RD STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6341
Practice Address - Country:US
Practice Address - Phone:317-528-4723
Practice Address - Fax:317-528-4699
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2023-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10001205A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant