Healthcare Provider Details

I. General information

NPI: 1801430731
Provider Name (Legal Business Name): HAROLD GREGORY HORN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N MAYO TRL STE 3
PAINTSVILLE KY
41240-1811
US

IV. Provider business mailing address

520 N MAYO TRL STE 3
PAINTSVILLE KY
41240-1811
US

V. Phone/Fax

Practice location:
  • Phone: 606-789-3188
  • Fax:
Mailing address:
  • Phone: 606-789-3188
  • Fax: 606-789-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3013919
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: