Healthcare Provider Details

I. General information

NPI: 1912336108
Provider Name (Legal Business Name): PATRICIA HORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W 4TH AVE
CANEY KS
67333-1462
US

IV. Provider business mailing address

218 W 4TH AVE
CANEY KS
67333-1462
US

V. Phone/Fax

Practice location:
  • Phone: 620-879-2182
  • Fax: 620-879-2246
Mailing address:
  • Phone: 620-879-2182
  • Fax: 620-879-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberT03790
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: