Individual
SUSAN D WORSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3300 NW EXPRESSWAY FL 2, OKLAHOMA CITY, OK 73112-4418
(405) 949-3417
(405) 552-5165
Mailing address
5300 N INDEPENDENCE AVE STE 280, OKLAHOMA CITY, OK 73112-5555
(405) 949-3417
(405) 552-5165
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100107320A
—
OK
01
—
P00145015
RAILROAD MEDICARE
OK
Enumeration date
05/24/2005
Last updated
05/24/2024
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