Provider Demographics
NPI:1871531616
Name:WORLOCK, TWILA (DNP PMHNP)
Entity type:Individual
Prefix:DR
First Name:TWILA
Middle Name:
Last Name:WORLOCK
Suffix:
Gender:F
Credentials:DNP PMHNP
Other - Prefix:
Other - First Name:TWILA
Other - Middle Name:
Other - Last Name:CURTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN CRNA
Mailing Address - Street 1:1050 N ARGONNE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-6011
Mailing Address - Country:US
Mailing Address - Phone:509-209-8990
Mailing Address - Fax:509-919-4877
Practice Address - Street 1:708 W FOREST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:731-541-7070
Practice Address - Fax:731-541-7075
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104755367500000X
WAAP60868627363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4089638OtherBLUE CROSS
MS03470247Medicaid
TN3633676Medicaid
P00216880OtherRAILROAD MEDICARE
P00216880OtherRAILROAD MEDICARE