Healthcare Provider Details

I. General information

NPI: 1871531616
Provider Name (Legal Business Name): TWILA WORLOCK DNP PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TWILA CURTICE MSN CRNA

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W FOREST AVE
JACKSON TN
38301
US

IV. Provider business mailing address

1050 N ARGONNE RD STE 102
SPOKANE VALLEY WA
99212-6011
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-7070
  • Fax: 731-541-7075
Mailing address:
  • Phone: 509-209-8990
  • Fax: 509-919-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number104755
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60868627
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: