MEDICARE: JP WORNOCK, MD, PA

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	261Q00000X	Clinic/Center	BL2016-00512	AR

General Provider Information

NPI Number	:	1407307788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JP WORNOCK, MD, PA

Provider Business Mailing Address
First Line	:	2504 MCCAIN BLVD
Second Line	:	STE 118
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7607
Country	:	US
Telephone Number	:	501-812-6655
Fax Number	:	501-812-6677

Provider Business Practice Location Address
First Line	:	2504 MCCAIN BLVD
Second Line	:	STE 118
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7607
Country	:	US
Telephone Number	:	501-812-6655
Fax Number	:	501-812-6677

Authorized Official
Title or Position	:	HUMAN CAPITAL COORDINATOR
Name	:	EMILY HARRELL
Credential	:
Telephone Number	:	501-764-1800

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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