Active NPI
Kent Tilis Worthen, D.O.
- Psychiatry Physician
- Buckeye, AZ
National Provider Identifier
1295748804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 005741
- Practice address
- 26700 S US Highway 85
Az Corrections Lewis
Buckeye, AZ 85326-5024 - Phone
- (623) 386-6160
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 005741 | AZ | Primary |
| Psychiatry Physician | 2084P0800X | 4954099-1204 | UT |
Addresses
Primary practice location
26700 S US Highway 85
Az Corrections Lewis
Buckeye, AZ 85326-5024
Mailing address
26700 S US Highway 85
Az Corrections Lewis
Buckeye, AZ 85326-5024
Phone (623) 386-6160
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005741 | AZ | MD | Psychiatry Physician |
| 4954099-1204 | UT | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326412800000",
"number": "1295748804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26700 S US HIGHWAY 85",
"address_2": "AZ CORRECTIONS LEWIS",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853265024",
"telephone_number": "623-386-6160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26700 S US HIGHWAY 85",
"address_2": "AZ CORRECTIONS LEWIS",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853265024",
"telephone_number": "623-386-6160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WORTHEN",
"first_name": "KENT",
"middle_name": "TILIS",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2012-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AZ",
"license": "005741",
"primary": true
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "UT",
"license": "4954099-1204",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buckeye, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.