Healthcare Provider Details

I. General information

NPI: 1295658169
Provider Name (Legal Business Name): KATIE MARIE WORRALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 S US HIGHWAY 27 STE 100
SAINT JOHNS MI
48879-2423
US

IV. Provider business mailing address

1005 S US HIGHWAY 27 STE 100
SAINT JOHNS MI
48879-2423
US

V. Phone/Fax

Practice location:
  • Phone: 989-224-3000
  • Fax: 989-668-0423
Mailing address:
  • Phone: 989-224-3000
  • Fax: 989-668-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704344067
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: