Healthcare Provider Details

I. General information

NPI: 1285558833
Provider Name (Legal Business Name): ANGELA HORN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 RODEO DR
MOUNTAIN HOME AR
72653-4540
US

IV. Provider business mailing address

1123 PROMISE LAND RD
MOUNTAIN HOME AR
72653-2011
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-1231
  • Fax:
Mailing address:
  • Phone: 870-530-0613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL046173
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: