Healthcare Provider Details

I. General information

NPI: 1366803645
Provider Name (Legal Business Name): MARY KATHERINE HORNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATHERINE GREEN PA-C

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33672 BAYVIEW MEDICAL DR FL 1
LEWES DE
19958-1687
US

IV. Provider business mailing address

33672 BAYVIEW MEDICAL DR FL 1
LEWES DE
19958-1687
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-2437
  • Fax: 833-629-0820
Mailing address:
  • Phone: 302-645-2437
  • Fax: 833-629-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0001050
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: