Healthcare Provider Details

I. General information

NPI: 1467278457
Provider Name (Legal Business Name): ALEXIS ANN HORTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 DEPOT ST
WALDOBORO ME
04572-5913
US

IV. Provider business mailing address

126 DEPOT ST
WALDOBORO ME
04572-5913
US

V. Phone/Fax

Practice location:
  • Phone: 207-832-6394
  • Fax: 207-536-5162
Mailing address:
  • Phone: 207-832-6394
  • Fax: 207-536-5162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3010
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: