Healthcare Provider Details

I. General information

NPI: 1154918134
Provider Name (Legal Business Name): DAVID HORNE PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2020
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 N LITEN GATA CIR
PALMER AK
99645-9220
US

IV. Provider business mailing address

9105 N LITEN GATA CIR
PALMER AK
99645-9220
US

V. Phone/Fax

Practice location:
  • Phone: 907-390-0949
  • Fax:
Mailing address:
  • Phone: 907-390-0949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number123456789
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number142653
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: