Healthcare Provider Details

I. General information

NPI: 1689197147
Provider Name (Legal Business Name): JACQUELINE KAYE HORNE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 10/17/2023
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 LINCOLNWAY STE B
VALPARAISO IN
46383-5728
US

IV. Provider business mailing address

606 LINCOLNWAY
VALPARAISO IN
46383-5728
US

V. Phone/Fax

Practice location:
  • Phone: 219-247-4003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041378331
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209016582
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71014248A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28228659A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: