MEDICARE: QUACK HEALTH PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1861190225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUACK HEALTH PLLC

Provider Business Mailing Address
First Line	:	3404 W CHERYL DR STE A150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9615
Country	:	US
Telephone Number	:	602-503-2832
Fax Number	:	888-571-5760

Provider Business Practice Location Address
First Line	:	3404 W CHERYL DR STE A150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9615
Country	:	US
Telephone Number	:	602-510-6582
Fax Number	:	888-571-5760

Authorized Official
Title or Position	:	OWNER
Name	:	RUSSELL HORNING
Credential	:	PMHNP
Telephone Number	:	602-503-2832

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	03/04/2026

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Directions to “QUACK HEALTH PLLC ” Practice Location

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