Provider Demographics
NPI:1750457362
Name:WORLEY, ARNOLD VICTOR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ARNOLD
Middle Name:VICTOR
Last Name:WORLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12222 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3755
Mailing Address - Country:US
Mailing Address - Phone:469-218-0678
Mailing Address - Fax:469-587-6684
Practice Address - Street 1:12222 N CENTRAL EXPY
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3755
Practice Address - Country:US
Practice Address - Phone:469-218-0678
Practice Address - Fax:469-587-6684
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN 067122367500000X
LAAP 02726367500000X
TX046058 AANA367500000X
TX767221163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203047002Medicaid
57602OtherCLINICAL
LA1674371Medicaid
TX203047002Medicaid
TXTXB126766Medicare PIN