Healthcare Provider Details

I. General information

NPI: 1174745947
Provider Name (Legal Business Name): VICTOR HORN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 E MADISON ST
HOUSTON MS
38851-2308
US

IV. Provider business mailing address

457 E MADISON ST STE 2
HOUSTON MS
38851-2308
US

V. Phone/Fax

Practice location:
  • Phone: 662-456-4277
  • Fax: 662-456-9589
Mailing address:
  • Phone: 662-456-4277
  • Fax: 662-456-9589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR HORN
Title or Position: OWNER
Credential: MD
Phone: 662-456-4277