Provider Demographics
NPI:1316938095
Name:WORTHINGTON, JODIE B (CNM, WHNP-BC)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:B
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2776
Mailing Address - Country:US
Mailing Address - Phone:866-904-7721
Mailing Address - Fax:509-545-8932
Practice Address - Street 1:3901 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2776
Practice Address - Country:US
Practice Address - Phone:866-904-7721
Practice Address - Fax:505-545-8932
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010157367A00000X
WAAP60857005363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA118933Medicare PIN
Q43274Medicare UPIN