Provider Demographics
NPI:1750388674
Name:WORLEY, KATHY S (FNP)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:S
Last Name:WORLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WINDY RD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-4004
Mailing Address - Country:US
Mailing Address - Phone:434-324-9150
Mailing Address - Fax:434-324-8248
Practice Address - Street 1:213 WINDY RD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-4004
Practice Address - Country:US
Practice Address - Phone:434-324-9150
Practice Address - Fax:434-324-8248
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024102880363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00412956OtherMEDICARE RAILROAD PROVIDER NUMBER
VA010112991Medicaid
P00412956OtherMEDICARE RAILROAD PROVIDER NUMBER
VA010112991Medicaid
VA014913C58Medicare PIN