MEDICARE: JENNIFER L WORSLEY ARNP FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP60585208	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104201623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L WORSLEY ARNP FNP-C

Provider Business Mailing Address
First Line	:	9537 GRAVELLY LAKE DR SW STE E10
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-1513
Country	:	US
Telephone Number	:	253-984-2000
Fax Number	:	253-426-6344

Provider Business Practice Location Address
First Line	:	9537 GRAVELLY LAKE DR SW STE E10
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-1513
Country	:	US
Telephone Number	:	253-984-2000
Fax Number	:	253-426-6344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	01/18/2021

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