MEDICARE: KATORRIA LAKEISHA HORN LPN, EMT-B

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	0002072601	VA

General Provider Information

NPI Number	:	1770995102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATORRIA LAKEISHA HORN LPN, EMT-B

Provider Business Mailing Address
First Line	:	421 HUNT AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2816
Country	:	US
Telephone Number	:	804-325-0418
Fax Number	:	877-216-7678

Provider Business Practice Location Address
First Line	:	421 HUNT AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2816
Country	:	US
Telephone Number	:	804-325-0418
Fax Number	:	877-216-7678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	05/20/2014

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