Healthcare Provider Details

I. General information

NPI: 1407307788
Provider Name (Legal Business Name): JP WORNOCK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 JOHNSON DR
SHERWOOD AR
72120-8025
US

IV. Provider business mailing address

10301 JOHNSON DR
SHERWOOD AR
72120-8025
US

V. Phone/Fax

Practice location:
  • Phone: 501-812-6655
  • Fax: 501-812-6677
Mailing address:
  • Phone: 501-812-6655
  • Fax: 501-812-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberBL2016-00512
License Number StateAR

VIII. Authorized Official

Name: ALEXIS ROWLAND
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 501-279-9000