Provider Demographics
NPI:1710576384
Name:WORTHAM, DEBBIE S (LPN)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:S
Last Name:WORTHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-3433
Mailing Address - Country:US
Mailing Address - Phone:580-658-3784
Mailing Address - Fax:580-658-3725
Practice Address - Street 1:801 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-3433
Practice Address - Country:US
Practice Address - Phone:580-658-3784
Practice Address - Fax:580-658-3725
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0050111164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKL0050111OtherLPN