MEDICARE: LYCURTIS WORTHAM

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1477217099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYCURTIS WORTHAM

Provider Business Mailing Address
First Line	:	51 47TH ST SE # 51
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-8412
Country	:	US
Telephone Number	:	202-997-0807
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 HAYES ST NE APT 322
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5571
Country	:	US
Telephone Number	:	202-868-3609
Fax Number	:

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

Provider Enumeration Date	:	10/29/2021
Last Update Date	:	10/29/2021

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Directions to “ LYCURTIS WORTHAM ” Practice Location

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