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General NPI Number Information
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NPI Number | 1407307788
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Entity Type | Organization
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Legal Business Name | JP WORNOCK, MD, PA
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 2504 MCCAIN BLVD STE 118
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7607
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Country | US
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Telephone | 501-812-6655
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Fax | 501-812-6677
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Provider Business Mailing Address
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Address Line | 2504 MCCAIN BLVD STE 118
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7607
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Country | US
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Telephone | 501-812-6655
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Fax | 501-812-6677
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Authorized Official
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Title or Position | HUMAN CAPITAL COORDINATOR
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Name | EMILY HARRELL
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Credential |
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Telephone | 501-764-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | BL2016-00512
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License Number State | AR
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