Healthcare Provider Details

I. General information

NPI: 1306580832
Provider Name (Legal Business Name): KATELYN MICHELLE HORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 E COMMERCIAL BLVD STE 405
FORT LAUDERDALE FL
33308-4029
US

IV. Provider business mailing address

1000 JEFFERSON ST STE 2C
LYNCHBURG VA
24504-1724
US

V. Phone/Fax

Practice location:
  • Phone: 855-284-7483
  • Fax: 617-807-0958
Mailing address:
  • Phone: 855-284-7483
  • Fax: 617-807-0958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN11018534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: