Provider Demographics
NPI:1982289633
Name:WORTHAM, NANNETTE L (HIS)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:L
Last Name:WORTHAM
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8322 JACK BOND RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-6920
Mailing Address - Country:US
Mailing Address - Phone:901-482-8262
Mailing Address - Fax:
Practice Address - Street 1:1561 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4756
Practice Address - Country:US
Practice Address - Phone:931-461-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN991237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist