Healthcare Provider Details

I. General information

NPI: 1003700683
Provider Name (Legal Business Name): TYRA WORTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12256 JERSEY MOUNTAIN RD
LEVELS WV
25431-4508
US

IV. Provider business mailing address

PO BOX 469
ROMNEY WV
26757-0469
US

V. Phone/Fax

Practice location:
  • Phone: 304-492-4013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: