Healthcare Provider Details

I. General information

NPI: 1427673821
Provider Name (Legal Business Name): MILLICENT LEIGH HORN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE DIV IM GENERAL MED, STE 241
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-5060
  • Fax: 314-362-6959
Mailing address:
  • Phone: 314-362-5060
  • Fax: 314-362-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022032316
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2022032316
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2022032316
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: