Healthcare Provider Details

I. General information

NPI: 1225307192
Provider Name (Legal Business Name): KATHLENE JOY HORSLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLENE JOY KENNEDY PA-C

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

2401 W BELVEDERE AVE SINAI HOSPITAL, DEPARTMENT OF SURGERY
BALTIMORE MD
21215
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-9000
  • Fax:
Mailing address:
  • Phone: 410-601-6025
  • Fax: 410-601-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004664
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: